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Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation

  • Original Article
  • Artificial Lung / ECMO
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Abstract

The aims of the present investigation, performed in 118 consecutive patients with refractory ARDS treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), were as follows: (a) to assess ICU mortality in overweight, obese and morbid obese patients in respect to normal weight; (b) to evaluate echocardiographic findings according to BMI subgroups. Echocardiography was performed before VV-ECMO implantation. Forty-five patients (38.1%) showed normal BMI, 37 patients (31.4%) were overweight and the remaining were obese (21.2%), or morbid obese (9.3%). Morbid obese showed the lowest ICU mortality rate (p = 0.003). No differences were detectable among BMI subgroups in echocardiographic findings apart from the fact that obese patients showed the lowest incidence of LV dysfunction (p = 0.015). At stepwise regression analysis the following variables were independent predictor of ICU mortality (when adjusted for age): RV dilatation (OR 4.361, 95 % CI 1.809–10.512, p < 0.001), BMI (OR 0.884, 95% CI 0.821–0.951, p < 0.001). In other terms, the presence of RV dilatation is an independent predictor of ICU mortality. In refractory ARDS treated with VV-ECMO, BMI > 30 kg/m2 is common (accounting for one-third of the entire population) but it is not associated with a worse outcome, so that it cannot be considered per se a contraindication to ECMO implantation. The incidence of RV dilatation and failure, which are known to negatively affect prognosis in ARDS patients, were comparable among BMI subgroups.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

BMI:

Body mass index

LV:

Left ventricle

RV:

Right ventricle

sPAP:

Systolic pulmonary arterial hypertension

TAPSE:

Tricuspid annular plane excursion

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

VV-ECMO:

Veno-venous extracorporeal membrane oxygenation

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy

    Chiara Lazzeri & Pasquale Bernardo

  2. Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Manuela Bonizzoli, Giovanni Cianchi, Stefano Batacchi, Paolo Terenzi, Morena Cozzolino & Adriano Peris

Authors
  1. Chiara Lazzeri
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  2. Manuela Bonizzoli
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  3. Giovanni Cianchi
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  4. Stefano Batacchi
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  5. Paolo Terenzi
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  6. Morena Cozzolino
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  7. Pasquale Bernardo
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  8. Adriano Peris
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Correspondence to Chiara Lazzeri.

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Lazzeri, C., Bonizzoli, M., Cianchi, G. et al. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs 20, 50–56 (2017). https://doi.org/10.1007/s10047-016-0931-8

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  • DOI: https://doi.org/10.1007/s10047-016-0931-8

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