Pulmonary management during extracorporeal membrane oxygenation

Keszler, Martin; Subramanian, K. N. Siva; Smith, Yolande F.; Dhanireddy, Ramasubbareddy; Mehta, Nitin; Molina, B. Muñoz; Cox, Cynthia; Moront, Michael G.

doi:10.1097/00003246-198906000-00002

Cited by 39 publications

(11 citation statements)

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“…This is achieved by gentle ('rest') ventilator settings whilst on ECMO, i.e 20/ 10cmH 2 O, 30% O 2 and 10 breaths per minute. The high PEEP has been shown to prevent alveolar collapse allowing faster weaning 39 . In the presence of severe barotrauma and air leaks, the lungs can be maintained static on CPAP until air leaks resolve.…”

Section: Oxygen Delivery Ventillation and Lung Management On Ecmomentioning

confidence: 99%

Extra-corporeal membrane oxygenation for paediatric respiratory failure

Peek¹,

Sosnowski²

1997

British Medical Bulletin

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Extracorporeal membrane oxygenation (ECMO) uses modified cardiopulmonary bypass technology to provide prolonged respiratory or cardiorespiratory support for patients of all ages who have failed conventional intensive care management. The use of ECMO for neonatal respiratory failure is now evidence-based following the publication of the randomised UK Collaborative Trial. ECMO use in children remains more controversial, but overall survival of 71% is possible in a group of moribund patients whose mean PaO2/FIO 2 ratio of 61 mmHg accurately predicts death in studies of conventional ventilation.Common diagnoses for children requiring ECMO support are pneumonia and the acute respiratory distress syndrome (ARDS).Extracorporeal membrane oxygenation (ECMO) uses modified cardiopulmonary bypass technology to provide prolonged cardiorespiratory support in the intensive care unit. ECMO is usually considered when a patient has an estimated mortality of 80% despite maximal treatment. Survival rate with ECMO is 50-95% depending on diagnosis and age group. We will discuss the principles of ECMO for paediatric respiratory failure, based on the Extracorporeal Life Support Organisation (ELSO) registry, published literature and our own experience.

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Section: Oxygen Delivery Ventillation and Lung Management On Ecmomentioning

confidence: 99%

Extra-corporeal membrane oxygenation for paediatric respiratory failure

Peek¹,

Sosnowski²

1997

British Medical Bulletin

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“…CDH is associated with significant rates of pulmonary morbidity and mortality that are thought to be because of the primary congenital defect as well as the mechanical ventilation that is necessary to sustain life [3][4][5]. To date, multiple modifications in clinical practice, such as the use of gentle ventilation and ECMO in place of increased ventilator pressures, have been implemented in attempts to decrease secondary lung injury in CDH patients [6][7][8][9][10][11][12]. These changes have been associated with improved clinical outcomes but at this time it is unknown if they actually decrease the amount of lung injury that is occurring because, to date, no objective measurement of lung injury during the clinical course of these infants has been performed.…”

Section: Discussionmentioning

confidence: 99%

“…with improved mortality and morbidity in several studies [6][7][8]. In addition, the use of ECMO rather than increasing ventilator support to extremely high pressures has become the standard approach in most institutions that manage CDH patients with severe disease [9][10][11][12].…”

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confidence: 99%

Evaluation of Lung Injury in Infants with Congenital Diaphragmatic Hernia

Marks

Landis

Lim

et al. 2019

Journal of Pediatric Surgery

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Background/Purpose: The presence of lung injury and the factors that contribute to it in infants with congenital diaphragmatic hernia (CDH) have not been objectively measured during their clinical course. In adults with acute respiratory distress syndrome, higher serum levels of surfactant protein D (SP-D) are linked to lung injury and worse outcomes. We hypothesized that serum SP-D levels would be elevated in CDH infants and that the levels would correlate to the amount of lung injury present. Methods: In this retrospective cohort study, serum SP-D levels were analyzed in 37 CDH infants and 5 control infants using a commercially available enzyme-linked immunosorbent assay kit. Results: Infants with more severe CDH had a statistically significant increase (p b 0.001) in serum SP-D over their first month of life. SP-D levels in CDH infants were similar to control infants while on extracorporeal membrane oxygenation (ECMO) but were 2.5-fold higher (p = 0.03) than controls following ECMO termination. SP-D levels increased 1.6-fold following surgical repair of the diaphragm and were significantly higher in the second week following surgery when compared to pre-operative levels (p b 0.03). Conclusions: These results demonstrate that CDH infants experience lung injury during the first week of life, around the time of surgery, and at the time of ECMO termination. Level II prognosis study.

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“…Mekanik ventilatör yönetimi ECMO desteği başlandıktan sonra "ECMO dinlenme ayarları" olarak adlandırılan disipline göre yapılır. Bu disiplinde genellikle dakikadaki solunum sayısı 10, pozitif ekspiryum sonu basıncı 10, oksijen konsantrasyonu %40 olarak ayarlanır (15). Mekanik destekteki pediyatrik hastalarda nöromuskuler bloker ilaçlar, benzodiazepinler ve narkotik analjezikler ile derin bir sedasyon sağlanması önerilir.…”

Section: Introductionunclassified

Pediyatrik kalp cerrahisinde ekstrakorporeal membran oksijenasyonu kullanımı

Ayık¹,

Işık²,

Akyüz³

et al. 2014

Ege Tıp Dergisi

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Ekstrakorporeal membran oksijenasyonu (ECMO), geleneksel tedavi yöntemlerine yanıt vermeyen tüm yaş gruplarında kalp veya solunum yetmezliği olan hastalarda kanıtlanmış bir tedavidir. Komplike konjenital kalp hastalıklı yenidoğan ve infantlarda artan kompleks kalp cerrahisi sonucunda ECMO kullanımı da artmaktadır. Belirgin mortalite ve morbiditeye sahip bu hasta grubunda ortalama sağkalım yaklaşık olarak %40 civarındadır. Hasta seçimi ECMO kullanım başarısı için çok önemlidir. ECMO'nun kullanımında başarının anahtarı deneyimli ve multidisipliner ekip çalışmasıdır. Pediatrik kalp cerrahisinde ECMO yaygın kullanım alanları; standart tedavilere yanıtsız kardiyorespiratuvar yetmezlik, kardiyopulmoner bypasstan ayrılamama ve düşük kardiyak output sendromu sayılabilir. Bu yazıda pediatrik kalp cerrahisinde ECMO'nun endikasyonları ve uygulama alanları değerlendirildi.Anahtar Sözcükler: Ekstrakorporeal membran oksijenasyonu, kardiyak cerrahi, konjenital kalp hastalıkları. Summary Extracorporeal membrane oxygenation (ECMO) is a proven therapy for patients with cardiac or respiratory failure across all age groups who do not respond to conventional treatment modalities. Increasing complex repairs in neonates and infants with complicated congenital heart diseases have led to the increased use of extracorporeal membrane oxygenation (ECMO) support. Use of ECMO in such a high-risk population is associated with

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Pulmonary management during extracorporeal membrane oxygenation

Cited by 39 publications

References 0 publications

Extra-corporeal membrane oxygenation for paediatric respiratory failure

Extra-corporeal membrane oxygenation for paediatric respiratory failure

Evaluation of Lung Injury in Infants with Congenital Diaphragmatic Hernia

Pediyatrik kalp cerrahisinde ekstrakorporeal membran oksijenasyonu kullanımı

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