(1483) The Impact of Tracheostomy on Lung Compliance in Patients With ARDS on VV ECMO

Introduction: Severe hypoxemia is generally considered a contraindication to percutaneous tracheostomy. However, studies have shown that the procedure is safe for patients with ARDS undergoing VV ECMO, with minimal impact on oxygenation. In addition to oxygenation impairment, patients with ARDS also have stiff non-compliant lungs that are sensitive to derecruitment which would be expected to occur during tracheostomy. Currently, there is no published data examining lung compliance before and after percutaneous tracheostomy in patients with ARDS on VV ECMO.

We hypothesized that lung compliance would decrease after the procedure but would rebound to initial values within 24 hours.

Methods: We performed a retrospective single center study of adult patients with ARDS supported with VV ECMO who underwent percutaneous tracheostomy between January 2017 and April 2024. Ventilator settings, ECMO settings, and sedation requirements were collected on the day before, the day of, and the day after the tracheostomy was performed. In hospital mortality was also collected. The study was approved by the institutional review board.

Results: Out of 113 patients screened, 22 met the inclusion criteria, but 5 patients were excluded for incomplete data. The mean lung compliance (mL/cm H2O) was 19.2 (IQR 11.3, 26.7) the day prior to tracheostomy, 17.1 (IQR 9.1, 22.5) the day of tracheostomy and 19.0 (IQR 9.1, 24.2) the day after tracheostomy. Mean ECMO flow (L/min) remained constant at 4.0, 4.0 and 4.1. Mean SGF (L/min) also was relatively unchanged at 3.8, 3.8 and 4.0. There was a slight decrease in sedation requirements: propofol (mcg/kg/min) – 15.3 prior to tracheostomy and 14.9 after, midazolam (mg/hr) – 4.1 prior to tracheostomy and 3.2 after, dexmedetomidine (mcg/kg/hr) – 0.5 prior to tracheostomy and 0.4 after. Two tailed T-test was performed on lung compliance and sedation requirements pre and post procedure and there were no statistically significant findings at the p< 0.05 level. 9 patients (52%) survived to hospital discharge.

Conclusions: Percutaneous tracheostomy is a safe procedure with minimal transient effects on lung compliance. However, a larger and more granular trial is needed to better delineate this relationship. An apparent benefit to tracheostomy is a trend toward decreasing sedation requirements.