Evidence map›Paper›PMID 41272741›Full record

Observational studyCritical care (London, England)2025

Physiology-guided management of patients with severe hypoxemia ineligible for ECMO: a multidisciplinary lung rescue team approach.

Florencia Rodríguez Sendic, Cristina Mietto, Glasiele Alcala, Roberta Ribeiro De Santis Santiago, Stefano Spina, Bijan Safaee Fakhr, Timothy Gaulton, Edward A Bittner, Carolyn J LaVita, Maurizio Cereda and 1 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Florencia Rodríguez SendicAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Cristina MiettoAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Glasiele AlcalaAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Roberta Ribeiro De Santis SantiagoAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Stefano SpinaAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Bijan Safaee FakhrAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Timothy GaultonAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Edward A BittnerAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Carolyn J LaVitaAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Maurizio CeredaAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Lorenzo BerraAnesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. lberra@mgh.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundARDS affects a significant proportion of ventilated ICU patients and carries high mortality, especially in cases of severe hypoxemia unresponsive to standard treatments and ineligible for extracorporeal membrane oxygenation (ECMO). In such situations, care often shifts to comfort measures due to limited data and structured guidance. To address this gap, Massachusetts General Hospital established the Lung Rescue Team (LRT), a multidisciplinary group using advanced physiological tools to provide individualized, real-time management beyond protocolized care.

objectiveTo evaluate the feasibility and application of a complex, physiology-guided framework in patients with severe hypoxemia who had not responded to standard or advanced interventions and were ineligible for rescue therapies such as ECMO, population typically excluded from clinical trials and often regarded as beyond curative treatment.

designThis single-center, retrospective observational study included adult patients in the intensive care unit (ICU) (n = 58) with severe hypoxemia not eligible for ECMO who were evaluated by the LRT at Massachusetts General Hospital between 2014 and 2025. Multimodal physiological assessments were performed which included electrical impedance tomography (EIT), esophageal manometry (EM), and transthoracic echocardiography (TTE). Interventions were categorized and clinical outcomes assessed.

resultsLRT consultation led to changes in respiratory management in 82.3% of patients who had already attend to receive maximal therapy, most commonly adjustments to PEEP based on EIT or transpulmonary pressure. The median ICU length of stay was 18.5 days (IQR 10.5–31.5). Survival was 48.3% at 90 days and 44.8% at 1 year. The leading cause of death was multiorgan failure (50%), followed by hypoxemia (25%) and unresponsive shock (25%).

conclusionsThis study describes the experience of a physiology-guided, multidisciplinary LRT in patients with severe hypoxemia ineligible for ECMO, individuals often excluded from clinical trials and frequently considered beyond curative treatment. Survival in this cohort was far from negligible, highlighting the value of systematic re-evaluation rather than premature transition to palliation. Although causal inferences cannot be drawn from this retrospective, single-center analysis, the findings provide insight into an underreported population and generate hypotheses for future prospective studies.

Indexed as

HypoxiaAdultAgedExtracorporeal Membrane OxygenationFemaleHumansIntensive Care UnitsMaleMassachusettsMiddle AgedPatient Care TeamRespiratory Distress SyndromeRetrospective StudiesECMOElectrical impedance tomographyEsophageal manometryIndividualized treatmentLung rescue teamRespiratory insufficiencySevere hypoxemiaStandard of care

Identifiers

PMID41272741
PMCPMC12639758

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.