From the Guidelines
A good arterial pO2 while on VV-ECMO should be maintained between 70-90 mmHg or SaO2 between 92-97%. This target range is based on the latest expert opinion in critical care medicine 1. The goal of VV-ECMO is to provide adequate tissue oxygenation, and maintaining a pO2 within this range is generally sufficient to meet tissue oxygen demands.
Key Considerations
- The actual pO2 target should be individualized based on the patient's specific condition, underlying pathology, and metabolic demands.
- Factors such as hemoglobin level, cardiac output, and tissue perfusion also influence the adequacy of oxygen delivery.
- Regular assessment of mixed venous oxygen saturation (SvO2) or central venous oxygen saturation (ScvO2) provides valuable information about the balance between oxygen delivery and consumption, helping to determine if the current pO2 is adequate for the patient's needs.
- Clinicians should avoid excessive oxygenation (supranormal pO2 levels) as this may increase the risk of oxygen toxicity and free radical damage without providing additional clinical benefit.
Clinical Evidence
The recommended pO2 range is supported by recent studies on respiratory support in patients with acute respiratory distress syndrome (ARDS) 1. While these studies do not specifically focus on VV-ECMO, they provide valuable insights into the management of oxygenation in critically ill patients.
Individualized Approach
It is essential to note that the optimal pO2 target may vary depending on the individual patient's condition and response to VV-ECMO. Close monitoring of the patient's oxygenation status, hemodynamics, and overall clinical condition is crucial to ensure that the pO2 target is adjusted accordingly.
From the Research
Arterial Oxygenation on VV-ECMO
- The ideal pO2 arterial level while on VV-ECMO is not explicitly stated in the provided studies, but we can look at related information on oxygenation management during VV-ECMO.
- A study on veno-venous extracorporeal membrane oxygenation 2 discusses the management of hypoxemia during VV-ECMO, proposing a stepwise approach to improve oxygenation, but does not specify a target pO2 level.
- Another study focusing on veno-arterial ECMO 3 mentions that recent guidelines recommend targeting a postoxygenator partial pressure of oxygen (PPOSTO2) around 150 mmHg, but this is in the context of VA-ECMO, not VV-ECMO.
- Studies on VV-ECMO 4 show improvements in oxygenation, as measured by the PaO2/FiO2 ratio, after interventions such as prone positioning, but do not provide a specific target pO2 arterial level.
- The management of oxygenation during VV-ECMO involves considering multiple factors, including pump flow, recirculation, cardiac output, and oxygenator function 2, but a specific target for arterial pO2 is not defined in the provided evidence.
Oxygenation Targets
- While there isn't a direct recommendation for a "good" pO2 arterial level on VV-ECMO from the studies provided, the goal is generally to achieve adequate oxygenation without causing hyperoxemia or hypoxemia.
- The study on VA-ECMO 3 highlights the importance of avoiding both hypoxemia and severe hyperoxemia, suggesting a balanced approach to oxygenation management, but the specific target may vary depending on the patient's condition and the type of ECMO support.
- For VV-ECMO, the focus is on improving oxygenation parameters such as the PaO2/FiO2 ratio, as seen in studies on interventions like prone positioning 4, but the ideal arterial pO2 level remains to be explicitly defined in the context of VV-ECMO management.