The impact of mechanical ventilation time before initiation of extracorporeal life support on survival in pediatric respiratory failure

Domico, Michele; Ridout, Deborah; Bronicki, Ronald A.; Anas, Nick; Cleary, John P.; Cappon, James; Goldman, Allan; Brown, Kate

doi:10.1097/pcc.0b013e3182192c66

Cited by 46 publications

(30 citation statements)

References 21 publications

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“…Type III phosphodiesterase inhibitors (amrinone, milrinone, enoximone) and the calcium sensitizer levosimendan can be helpful because they overcome receptor desensitization. Forty-one percent of children with a diagnosis of sepsis requiring ECMO for respiratory failure survive to hospital discharge (573). In two RCTs, pentoxifylline reduced mortality from severe sepsis in newborns (510,(560)(561)(562)(563)(564)(565)(566)(567)(568)(569) Rationale.…”

Section: We Suggest That Patients With Low Cardiac Output and Elevatedmentioning

confidence: 99%

Surviving Sepsis Campaign

Dellinger

Mm²,

Rhodes³

et al. 2013

Critical Care Medicine

5,454

1,927

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Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.

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Section: We Suggest That Patients With Low Cardiac Output and Elevatedmentioning

confidence: 99%

Surviving Sepsis Campaign

Dellinger

Mm²,

Rhodes³

et al. 2013

Critical Care Medicine

5,454

1,927

View full text Add to dashboard Cite

show abstract

“…In previous reports, the mortality was higher if ECMO was started after 7 days of high‐level ventilation . This was not found here or in the ELSO registry for children . Therefore, prolonged mechanical ventilation should not be considered as a contraindication.…”

Section: Discussionmentioning

confidence: 54%

Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation

et al. 2017

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The risk of cardiac or lung failure after liver transplantation (LT) is significant. In rare cases, the usual intensive care techniques fail to maintain organ oxygenation with a risk of multiorgan dysfunction. Although extracorporeal membrane oxygenation (ECMO) is a difficult and risky procedure, it can be proposed as life-saving. Four children with either acute pulmonary (three) or cardiac (one) failure after LT, and the criteria that decided the use of ECMO (level of ventilation and results, dosage of inotropic drugs, cardiac ultrasound, blood lactate) were retrospectively reported. These patients, 1-11 years old, were treated with either veno-arterial (three) or veno-venous (one) ECMO. Two experienced a full recovery, with 3 and 6 years of follow-up. Two died of systemic inflammatory response syndrome (SIRS) due to ECMO, and relapse of heart failure due to the underlying disease. Although our patients' survival was only 50%, we showed that ECMO can be useful in children after LT. It should be considered before the development of irreversible multiorgan failure.

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“…To this end, prior studies have reported an association between longer duration of pre-ECMO mechanical ventilation and poor patient survival [9–11]. Of note, the majority of respondents in the current study did not consider the duration of mechanical ventilation during an index hospitalization an important trigger for transfer and felt other considerations such as illness severity, the presence of ARDS, and suitability for ECMO were more germane to the decision making than the duration of mechanical ventilation solely.…”

Section: Discussionmentioning

confidence: 99%

Interhospital transfer of children in respiratory failure: a clinician interview qualitative study

Odetola

Anspach

Han

et al. 2017

Journal of Critical Care

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Purpose To investigate the decision making underlying transfer of children with respiratory failure from Level II to Level I pediatric intensive care unit (PICU) care. Methods Interviews with 19 eligible Level II PICU physicians about a hypothetical scenario of a 2 year old girl in respiratory failure: Baseline Ventilator settings: rate 25, peak inspiratory pressure 28, positive end-expiratory pressure 8, fraction of inspired oxygen (FIO2) 100%. Escalation Point (EP) 1 After 8 hours. Higher ventilator settings; oxygenation index (OI) 32. EP 2 Three hours later. OI 40. Results At baseline, indices critical to management were: OI (53%), PaO2: FIO2 [P/F] (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and FIO2; and low P/F. At EP 1, 18/19 respondents would initiate high frequency oscillatory ventilation–HFOV, and one would transfer. At EP 2, 15/18 respondents would maintain HFOV, 9 of them calling to discuss transfer. All respondents would transfer if escalated therapies failed to reverse the patient’s clinical deterioration. Conclusion Interhospital transfer of children in respiratory failure is triggered by poor response to escalation of locally available care modalities. This finding provides new insight into decision-making underlying interhospital transfer of children with respiratory failure.

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The impact of mechanical ventilation time before initiation of extracorporeal life support on survival in pediatric respiratory failure

Cited by 46 publications

References 21 publications

Surviving Sepsis Campaign

Surviving Sepsis Campaign

Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation

Interhospital transfer of children in respiratory failure: a clinician interview qualitative study

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