What We Need To Learn Each year, millions of people in the U.S. become critically ill and requiresupport from a breathing machine (invasive mechanical ventilation).  About 25-35% of critically ill…

When people become very sick and their lungs cannot give the body enough oxygen, they may need help from a machine that works like an external lung. This machine, called Veno‑Venous Extracorporeal Membrane Oxygenation (V-V ECMO), takes blood out of a patient’s vein, pushes oxygen into the blood and pulls carbon dioxide out of the blood, and returns the blood to the patient’s vein. While V-V ECMO saves lives, patients receiving V-V ECMO may also experience severe complications. Doctors try to take patients off V-V ECMO at the earliest time that it would be safe to do so. Hospitals use different methods to determine when to remove patients from VV-ECMO, but there is little research showing which approach works best.

Seriously ill patients sometimes need a breathing machine to help them breathe.  Doctors or respiratory therapists select settings on the breathing machine that determine how the patient receives each breath – referred to as the “mode”.  Three modes are common: volume control, pressure control, and adaptive pressure control. All 3 are considered safe and effective, but it is not known if one breathing machine mode is better than the others.

To safely connect a patient to a breathing machine, doctors place a breathing tube through the mouth, past the vocal cords, and into the windpipe. To do this, they use a tool called a “video laryngoscope” to see the vocal cords and guide the breathing tube into place.

Each year millions of seriously ill adults need life-saving treatment with a breathing machine. To place someone on a breathing machine, doctors must place a breathing tube through the patient’s mouth and into the windpipe (a procedure known as “intubation”).  When sick patients are placed on a breathing machine in an emergency department or intensive care unit (ICU), doctors commonly give patients a medicine to make them sleepy and comfortable (a “sedative”) while the breathing tube is being placed.  Many doctors also give a second medication to temporarily immobilize the patient’s muscles to make it easier to place the breathing tube (a “neuromuscular blocker”).  Which approach is best is uncertain.

To safely connect a patient to a breathing machine, doctors place a breathing tube through the mouth and between the vocal cords (intubation). A breathing tube can put pressure on a patient’s voice box and cause an ulcer (similar to how shoes can cause blisters on feet). If an ulcer develops, it can cause long-term problems with breathing, speaking, and swallowing even after the tube is taken out. Some breathing tubes are smaller and some are larger.  Using smaller breathing tubes may prevent these long-term problems with breathing, speaking, and swallowing, whereas using larger breathing tubes may help patients get off of the breathing machine faster.