CONJUNCTIVE USE OF HIGH FREQUENCY PERCUSSIVE VENTILATION WITH EXTRACORPOREAL MEMBRANE OXYGENATION FOR ARDS DUE TO LEGIONELLA PNEUMONIA INFECTION

Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores <70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

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Diagnosis-Related Criteria in the Consideration of Extracorporeal Membrane Oxygenation in Neonates Previously Treated With High-Frequency Jet Ventilation

PEDIATRICS ◽

10.1542/peds.89.3.491 ◽

1992 ◽

Vol 89 (3) ◽

pp. 491-494

Author(s):

Stephen Baumgart ◽

Ronald B. Hirschl ◽

Sharon Z. Butler ◽

Christine E. Coburn ◽

Alan R. Spitzer

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

High Frequency ◽

Distress Syndrome ◽

Air Leak ◽

Jet Ventilation ◽

Meconium Aspiration ◽

High Frequency Jet Ventilation ◽

Membrane Oxygenation

High-frequency jet ventilation (HFJV) is one of several high-frequency techniques that are particularly valuable for treating the neonate with lung disease refractory to conventional ventilation or with pulmonary air leak. Extracorporeal membrane oxygenation (ECMO) has also emerged as a valuable rescue therapy for neonates of more than 2000 g birth weight and 34 weeks's gestation with intractable respiratory failure. With the concurrent introduction of HFJV and ECMO, the authors sought to evaluate the role of HFJV prior to the institution of ECMO therapy. The data base for 2856 neonates receiving mechanical ventilation in one unit was used to identify 73 (of 298 total) neonates treated with HFJV, who were eligible by age and weight criteria for ECMO. Patients were grouped by diagnosis, and the oxygenation index (OI) was calculated during therapy. Outcome was evaluated for mortality, and the sensitivity of the OI for predicting mortality was calculated. Neonates who survived with HFJV alone presented with an OI of 0.30 ± 0.03 (SEM), significantly less than nonsurvivors (0.42 ± 0.04, P = .016). Survivors responded to HFJV with a rapid decrease in OI at 1 hour (0.19 ± 0.02, P < .001) and 6 hours (0.15 ± 0.01, P < .001). Nonsurvivors did not respond significantly at 1 hour (OI = 0.33 ± 0.04, P = not significant [NS]) or at 6 hours (OI = 0.40 ± 0.06, P = NS). By diagnosis, neonates with respiratory distress syndrome survived more often with HFJV (28/34, 82%) than neonates with meconium aspiration (10/26, 38%) or diaphragmatic hernia (3/9, 33%). Neonates with respiratory distress syndrome seldom presented with high OI values, but the majority of those who did survived (5/7 survived with initial OI ≥ 0.40). Neonates with meconium aspiration and a single OI ≥ 0.40 on presentation fared much worse: 13 (87%) of 15 died. From these results, it appears that neonates with severe intractable respiratory distress syndrome and/or air leak are most likely to respond favorably within 6 hours of starting HFJV. In contrast, neonates with meconium aspiration respond far less well and may require early ECMO intervention, particularly with a single OI ≥ 0.40.

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Frequency of chronic lung disease in infants with severe respiratory failure treated with high-frequency ventilation and/or extracorporeal membrane oxygenation

Critical Care Medicine ◽

10.1097/00003246-199203000-00014 ◽

1992 ◽

Vol 20 (3) ◽

pp. 372-377 ◽

Cited By ~ 20

Author(s):

CLAIR A. SCHWENDEMAN ◽

REESE H. CLARK ◽

BRADLEY A. YODER ◽

DONALD M. NULL ◽

DALE R. GERSTMANN ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Lung Disease ◽

Chronic Lung Disease ◽

High Frequency ◽

High Frequency Ventilation ◽

Severe Respiratory Failure ◽

Membrane Oxygenation ◽

Frequency Ventilation

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High-Frequency Ventilation and Extracorporeal Membrane Oxygenation

AACN Advanced Critical Care ◽

10.4037/15597768-1990-2022 ◽

1990 ◽

Vol 1 (2) ◽

pp. 427-444 ◽

Cited By ~ 1

Author(s):

Charmaine White ◽

Cliff Richardson ◽

Libertad Raibstein

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

High Frequency ◽

Assisted Ventilation ◽

Pulmonary Complications ◽

High Frequency Ventilation ◽

Dramatic Improvement ◽

Membrane Oxygenation ◽

Frequency Ventilation ◽

Short And Long Term

Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. Short-and long-term pulmonary complications continue to be of major concern. New ways to support the neonate in respiratory failure are being investigated. Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO)

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Outcomes of severe Legionella pneumonia requiring extracorporeal membrane oxygenation (ECMO)

Journal of Critical Care ◽

10.1016/j.jcrc.2020.10.017 ◽

2021 ◽

Vol 61 ◽

pp. 103-106

Author(s):

Ali Naqvi ◽

Sumit Kapoor ◽

Mallika Pradhan ◽

Peter V. Dicpinigaitis

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Legionella Pneumonia

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High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

European Journal of Pediatrics ◽

10.1007/bf01959088 ◽

1992 ◽

Vol 151 (10) ◽

pp. 769-774 ◽

Cited By ~ 31

Author(s):

V. Varnholt ◽

P. Lasch ◽

G. Suske ◽

W. Kachel ◽

W. Brands

Keyword(s):

Pulmonary Hypertension ◽

Extracorporeal Membrane Oxygenation ◽

High Frequency ◽

High Frequency Oscillatory Ventilation ◽

Persistent Pulmonary Hypertension ◽

Oscillatory Ventilation ◽

Membrane Oxygenation ◽

High Frequency Oscillatory

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The use of high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) in the management of the term/near term infant with respiratory failure

Early Human Development ◽

10.1016/0378-3782(92)90181-f ◽

1992 ◽

Vol 29 (1-3) ◽

pp. 299-303 ◽

Cited By ~ 20

Author(s):

R. deLemos ◽

B. Yoder ◽

D. McCurnin ◽

J. Kinsella ◽

R. Clark ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

High Frequency ◽

High Frequency Oscillatory Ventilation ◽

Term Infant ◽

Oscillatory Ventilation ◽

Membrane Oxygenation ◽

Near Term ◽

High Frequency Oscillatory

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Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia

Journal of Intensive Care Medicine ◽

10.1177/0885066617700121 ◽

2017 ◽

Vol 34 (4) ◽

pp. 344-350 ◽

Cited By ~ 3

Author(s):

Roberto Roncon-Albuquerque ◽

Rodrigo Vilares-Morgado ◽

Gert-Jan van der Heijden ◽

João Ferreira-Coimbra ◽

Paulo Mergulhão ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Invasive Mechanical Ventilation ◽

Ecmo Support ◽

Lung Protective Ventilation ◽

Survival Prediction ◽

High Survival ◽

Membrane Oxygenation ◽

Legionella Pneumonia

Objective: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. Design and Setting: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. Participants: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Results: Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2 ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to “lung rest” settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13). Conclusion: In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.

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