6, 8, 10
Flow set at initiation should not be left unchanged. Down-titration is an active daily process, and excess flow carries a fluid-balance cost.
Conventional practice of maintaining a constant extracorporeal blood flow rate until weaning
DOI 10.21037/jtd-20-1515
Daily protocol-driven down-titration of extracorporeal blood flow rate, with systematic optimisation of sweep gas flow and FdO2
Narrative proposal referencing protocols from high-volume centres. The authors acknowledge no randomised trials establish optimal weaning technique and call for prospective validation.
Proposes a three-stage approach: daily 300 mL/min decrements in extracorporeal blood flow rate to find the lowest tolerable value maintaining ultra-protective ventilation and SpO2 at or above 88%; a 100% FiO2 test targeting PaO2 at or above 250 mmHg to assess native lung recovery; and only then sequential reduction of sweep gas flow and FdO2. Rationale is that higher-than-necessary flow requires greater volume expansion, worsening extravascular lung water and complicating diuresis and sedation reduction.
Adults on venovenous ECMO