Q: 34 year old male has been put on extracorporeal membrane oxygenation (ECMO) due to ARDS. What should be the target parameters on ventilator?
Answer: Whole idea behind insertion of ECMO in severe ARDS is to "rest the lung". Ideally, all barotrauma, volutrauma and oxygen toxicity should be minimized. Target parameters should be plateau airway pressures less than 20 cm H2O and minimal FiO2 as tolerated. Added benefit of reduce positive pressure ventilation is improved venous return and cardiac output.