Extracorporeal membrane oxygenation in critically ill neonatal and pediatric patients with acute respiratory failure: a guide for the clinician

Scott, Briana; Bonadonna, Desiree; Ozment, Caroline; Rehder, Kyle J

doi:10.1080/17476348.2021.1932469

Cited by 3 publications

(5 citation statements)

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“…17 A review published in Expert Review of Respiratory Medicine states that sedation, analgesia, and neuromuscular blockade should be used for cannulation, and then lightened and minimized. 18 Some institutions perform "drug holidays" where sedation is held for a day to allow for neurologic exams and/or reduce SA exposure. 17 The feasibility of drug holidays in neonatal ECMO has been studied in a small, prospective, observational study that showed it to be safe without negative outcomes such as accidental extubation or decannulation.…”

Section: Discussionmentioning

confidence: 99%

“…For example, benzodiazepines, specifically those that are highly protein-bound (diazepam and midazolam), have a higher extraction during ECMO, compared to morphine, which is low-to-moderate extraction. 18,22 Such differences in pharmacokinetics can explain the escalating requirement of opioid and sedative needs while on ECMO over time. 2 It is important to note that phenobarbital is a cytochrome P450 inducer, therefore, it can increase the metabolism of medications such as midazolam.…”

Section: Discussionmentioning

confidence: 99%

“…Sedation-analgesia dose and duration pre-and post-phenobarbital protocol implementation protocol, there was a significant reduction in median total morphine dose(31.38 mg/kg [13.7-78.65] to 17.65 mg/kg [1.93-23.78], p ¼ 0.006) and median total midazolam dose (36.21 mg/kg [24.5-107.3] to 6.36 mg/kg [2.62-15.05],p < 0.001). There was also a reduction in median total days on morphine from 21.5 days (14-44) to 14 days(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) …”

mentioning

confidence: 99%

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Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation

Cardona,

Byrne,

Mejia

et al. 2024

Am J Perinatol

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Objective The study aims to describe our experience with the implementation of phenobarbital as a primary sedation strategy during neonatal extracorporeal membrane oxygenation (ECMO). Study Design Retrospective chart review in a level IV neonatal intensive care unit between 2011 and 2021 comparing neonatal ECMO patients before and after the implementation of a sedation-analgesia (SA) protocol using scheduled phenobarbital as the primary sedative. Groups were compared for neonatal and ECMO characteristics, cumulative SA doses, and in-hospital outcomes. Comparison between groups was performed using Mann–Whitney test on continuous variables and chi-square on nominal variables. Results Forty-two patients were included, 23 preprotocol and 19 postprotocol. Birth, pre-ECMO, and ECMO clinical characteristics were similar between groups except for a lower birth weight in the postprotocol group (p = 0.024). After standardization of phenobarbital SA protocol, there was a statistically significant reduction in median total morphine dose (31.38–17.65 mg/kg, p = 0.006) and median total midazolam dose (36.21–6.36 mg/kg, p < 0.001). There was also a reduction in median total days on morphine by 7.5 days (p = 0.026) and midazolam by 6.6 days (p = 0.003). There were no differences in ECMO duration or in-hospital outcomes between groups. Conclusion In this cohort, short-term use of phenobarbital as primary sedation strategy during neonatal ECMO was associated with reduced opioid and midazolam burden. Such reduction, however, did not affect in-hospital outcomes. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation

Cardona,

Byrne,

Mejia

et al. 2024

Am J Perinatol

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“…NRDS significantly contributed to infant mortality until the mid-1980s, when exogenous surfactant therapy was created [ 51 , 52 ]. It has been demonstrated that intratracheal administration of a pure form of animal surfactants to vulnerable patients significantly increases survival, as reported in network meta-analysis of randomized controlled trials.…”

Section: Clinical Uses Of Exogenous Surfactantmentioning

confidence: 99%

Surfactant replacement therapy as promising treatment for COVID-19: an updated narrative review

Khudadah,

Ramadan,

Othman

et al. 2023

Bioscience Reports

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Patients with COVID-19 exhibit similar symptoms to neonatal respiratory distress syndrome. SARS-CoV-2 spike protein has been shown to target alveolar type 2 lung cells which synthesize and secrete endogenous surfactants leading to acute respiratory distress syndrome in some patients. This was proven by post-mortem histopathological findings revealing desquamated alveolar type 2 cells. Surfactant use in patients with COVID-19 respiratory distress syndrome results in marked improvement in respiratory parameters but not mortality which needs further clinical trials comparing surfactant formulas and modes of administration to decrease the mortality. In addition, surfactants could be a promising vehicle for specific drug delivery as a liposomal carrier, which requires more and more challenging efforts. In this review, we highlight the current reviews and two clinical trials on exogenous surfactant therapy in COVID-19-associated respiratory distress in adults, and how surfactant could be a promising drug to help fight the COVID-19 infection.

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“…Among them, ARDS caused by sepsis is very common in clinic, and its fatality rate is also higher than ARDS caused by other reasons [ 2 , 3 ]. Moreover, the occurrence of ARDS in neonatus is more fatal, which is the most common problem in neonatal ICU and remains an important challenge for the intensive care clinician [ 4 ]. Studies have shown that the level of lipopolysaccharide (LPS) is closely related to the occurrence of ARDS caused by sepsis [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Protective Effect of Artesunate on LPS-Induced Acute Respiratory Distress Syndrome through Inhibiting NLRP3 Inflammasome Signaling

Cui

Weng²,

Ding

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Artesunate (AS) is a derivative of artemisinin that can exert anti-inflammatory effects. This study aims to explore the effect of AS on lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS). Methods. The newborn mice were used for experimental ARDS model establishment by intraperitoneal injection of LPS (10 mg/kg) into mice with or without AS (20 mg/kg) pretreatment. After that, the pathological morphology of mouse lung tissue was observed by H&E staining. The content of inflammatory factors in serum was measured by ELISA and mRNA expression and lung tissue was determined by qRT-PCR. The expression of NLRP3 inflammasome and related proteins in lung tissue was confirmed by immunohistochemistry and Western blot. Results. AS treatment effectively alleviated the LPS-induced lung injury and pulmonary edema, and reduced the expression of IL-1β, IL-18, IL-6, IL-8, MCP-1, and TNF-α in serum and lung tissues of experimental ARDS mice. In addition, AS treatment reduced the expression of NLRP3, ASC, and caspase-1 in lung tissues of experimental ARDS mice. Conclusion. AS alleviated LPS-induced lung injury in ARDS mice by inhibiting the activation of NLRP3 inflammasome.

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Extracorporeal membrane oxygenation in critically ill neonatal and pediatric patients with acute respiratory failure: a guide for the clinician

Cited by 3 publications

References 97 publications

Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation

Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation

Surfactant replacement therapy as promising treatment for COVID-19: an updated narrative review

The Protective Effect of Artesunate on LPS-Induced Acute Respiratory Distress Syndrome through Inhibiting NLRP3 Inflammasome Signaling

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