Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Zhang, Zhongheng; Gu, Wan Jie; Chen, Kun; Ni, Hongying

doi:10.1155/2017/1783857

Cited by 36 publications

(24 citation statements)

References 92 publications

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“…In our hospital the intensivists are in close collaboration with the cardiac surgery service (both cardiac surgeons and perfusionists) during cannulation and withdrawal of ECMO, as well as in all possible incidents and mechanical complications related to the technique [ 2 , 24 ]. The timing of ECMO is usually based on the severity of ARDS but there is evidence that early initiation of ECMO improves survival [ 2 , 12 , 25 ]. In all patients in this series, ECMO was started within 7 days of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation

Pedra

Koborzan

Sbraga

et al. 2018

Respiratory Medicine Case Reports

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IntroductionExtracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO.MethodsBetween July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain. These patients were treated with ECMO as salvage respiratory therapy. Outcomes included clinical data, ventilatory and blood gas characteristics, survival, and complications.ResultsFifteen patients (83.3%) were previously treated in prone position. The indication of VV-ECMO was established at an early stage after a mean (SD) of 3.8 (2.5) days on mechanical ventilation. The mean duration of ECMO was 10.4 days, and 16 patients (88.9%) required venous cannulation, mostly femoral-internal jugular. The mean length of ICU stay was 27 days and the mean hospital stay was 42.1 days. The ICU survival rate was 55.5% (n = 10) and the hospital survival rate was 50% (n = 9).ConclusionsThis clinical study in a small series of ICU patients treated with ECMO confirms the usefulness of this technique as a ventilatory support in patients with refractory hypoxemic respiratory failure. However, the indication of this procedure is also committed to an ethical reflection considering the possible futility of the measure on a case-by-case basis and associated complications.

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Section: Discussionmentioning

confidence: 99%

Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation

Pedra

Koborzan

Sbraga

et al. 2018

Respiratory Medicine Case Reports

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“…The use of a high PEEP may compromise pulmonary blood flow and cardiac output. The resting parameters to be achieved will be the same as for VA-ECMO, but we should use expired CO 2 to optimize PEEP [ 98 – 100 ].…”

Section: Care In Ecmomentioning

confidence: 99%

“…During ECMO treatment, mild and protective ventilatory strategies can and should be employed, without concern for ventilation/oxygenation, which is ensured by the technique employed [ 100 ].…”

Section: Care In Ecmomentioning

confidence: 99%

Respiratory Care for the Ventilated Neonate

Rocha¹,

Soares

Gonçalves³

et al. 2018

Canadian Respiratory Journal

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Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.

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“…Kanüller: Venöz kanüller perkütan veya cerrahi olarak yerleştirilebilirler. Drenaj kanülleri daha geniş çaplı (23)(24)(25)(26)(27)(28)(29)(30)(31), çok delikli ve uzundur, dönüş kanüllerinin ise küçük çaplı (15)(16)(17)(18)(19) Fr) seçilmesi yeterlidir. Kanül yerleştirilmesinde (VVECMO, femoro-femoral ven, femoro-internal jugular ven) ekokardigrafi ve radyolojik görüntüleme ile yerinin doğrulanması gerekir.…”

Section: Ecmo Bileşenleriunclassified

Extracorporeal Membrane Oxygenation

Bayar¹,

Kosovalı²

2018

GGHS

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Ekstrakorporeal membran oksijenizasyonu (ECMO) geleneksel tedaviye yanıt vermeyen hastalarda solunum ve/veya kardiyak fonksiyonların geçici olarak desteklenmesi işlemidir. Büyük damarlara yerleştirilen kanüller aracılığıyla eksternal pompa ile hastadan alınan kan membrandan (oksijenatör) geçirilip gaz değişimi sağlandıktan sonra hastaya tekrar geri verilmektedir. Genellikle pulmoner (venö-venöz) ve kardiyopulmoner (venö-arteriyel) destek için iki şekilde uygulanır. Akut ciddi geri dönüşümlü hastalıklarda sınırlı endikasyonlarla uygulanan ECMO sırasında hastanın yakından monitörizasyonu gereklidir. Hasta ve ECMO sistemine bağlı olarak çeşitli komplikasyonlarla karşılaşılabilir. Bu derlemede özellikle solunumsal destek amaçlı ECMO uygulamasının bileşenleri, fizyolojisi, komplikasyonları ve yönetimi hakkında bilgiler verilmesi amaçlanmıştır.

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Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Cited by 36 publications

References 92 publications

Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation

Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation

Respiratory Care for the Ventilated Neonate

Extracorporeal Membrane Oxygenation

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