Practical ventilator management

Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support patients with acute respiratory failure, most commonly, and severe forms of acute respiratory distress syndrome (ARDS). The marked increase in the global use of ECMO followed the publication of a large randomized trial in 2009 and the experience garnered during the 2009 influenza A (H1N1) pandemic, and has been further supported by the release of a large, randomized clinical trial in 2018, confirming a benefit from using ECMO in patients with severe ARDS. Despite a rapid expansion of ECMO-related publications, optimal management of patients receiving ECMO, in terms of patient selection, ventilator management, anticoagulation, and transfusion strategies, is evolving. Most recently, ECMO is being utilized for an expanding variety of conditions, including for cases of severe pulmonary or cardiac failure from coronavirus disease 2019 (COVID-19). This review evaluates modern evidence for ECMO for respiratory failure and the current challenges in the field.

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Acute Respiratory Distress Syndrome: Ventilator Management and Rescue Therapies

Critical Care Clinics ◽

10.1016/j.ccc.2021.05.008 ◽

2021 ◽

Author(s):

Melissa H. Coleman ◽

J. Matthew Aldrich

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Ventilator Management

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633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.283 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S172-S173

Author(s):

Lauren B Nosanov ◽

Kaitlyn Libraro ◽

Jamie Heffernan ◽

Philip H Chang ◽

Abraham Houng ◽

...

Keyword(s):

Intensive Care ◽

Ease Of Use ◽

Convenience Sample ◽

Team Members ◽

Sepsis Risk ◽

Burn Surgery ◽

Ventilator Management ◽

Patient Assessments ◽

Continued Use ◽

Additional Feedback

Abstract Introduction An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility. Methods A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use. Results Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning. Conclusions Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.

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Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

The International Journal of Artificial Organs ◽

10.1177/0391398821999386 ◽

2021 ◽

pp. 039139882199938

Author(s):

Matthew L Friedman ◽

Samer Abu-Sultaneh ◽

James E Slaven ◽

Christopher W Mastropietro

Keyword(s):

Mechanical Ventilation ◽

Extracorporeal Membrane Oxygenation ◽

Life Support ◽

Arterial Oxygen Saturation ◽

Peak Inspiratory Pressure ◽

Conventional Mechanical Ventilation ◽

Arterial Oxygen ◽

Multivariable Logistic Regression Analysis ◽

Membrane Oxygenation ◽

Ventilator Management

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.

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