• Francesco Zadek, Jonah Rubin, Luigi Grassi, Daniel Van Den Kroonenberg, Grant Larson, Martin Capriles, Roberta De Santis Santiago, Gaetano Florio, David A Imber, Edward A Bittner, Kathryn A Hibbert, Alex Legassey, Jeliene LaRocque, Gaston Cudemus-Deseda, Aranya Bagchi, Jerome Crowley, Kenneth Shelton, Robert Kacmarek, and Lorenzo Berra.
• Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
• Crit Care Explor. 2021 Jul 1; 3 (7): e0461.

ObjectiveTo investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality.DesignSingle-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019.PatientsAll patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure.InterventionEvaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation.Measurement And Main ResultsAll 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenation, whereas 10 of 13 patients (77%) evaluated by the lung rescue team did not receive venovenous extracorporeal membrane oxygenation. Patients who underwent lung rescue team evaluation had a shorter duration of mechanical ventilation (p = 0.03) and shorter ICU length of stay (p = 0.03). There were no differences between groups in in-hospital, 30-day, or 1-year mortality.ConclusionsIn this hypothesis-generating study, individualized optimization of mechanical ventilation of patients with acute respiratory distress syndrome and obesity by a lung rescue team was associated with a decrease in the utilization of venovenous extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention.Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

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