scholarly journals Successful Use of Extracorporeal Life Support after Double Traumatic Tracheobronchial Injury in a Patient with Severe Acute Asthma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Xavier Valette ◽  
Aurélie Desjouis ◽  
Massimo Massetti ◽  
Jean-Luc Hanouz ◽  
Philippe Icard
Keyword(s):  
Medical Treatment ◽  
Severe Asthma ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Ventilatory Support ◽  
Respiratory Acidosis ◽  
Acute Severe Asthma ◽  
Arterial Blood ◽  
Airway Pressures ◽  
Tracheobronchial Injury

We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.

Potentially (near) fatal asthma

2019 ◽  
Vol 40 (6) ◽  
pp. 403-405 ◽  
Author(s):  
Paul A. Greenberger
Keyword(s):  
Severe Asthma ◽  
Health Care Professionals ◽  
Rescue Therapy ◽  
Respiratory Acidosis ◽  
Acute Severe Asthma ◽  
Increased Risk ◽  
High Risk Type ◽  
Fatal Asthma ◽  
Long Acting ◽  
Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

Extracorporeal Life Support for a Patient With Severe Asthma

CHEST Journal ◽  
1994 ◽  
Vol 106 (1) ◽  
pp. 323 ◽  
Author(s):  
Shoji Ito ◽  
Hirotada Katsuya
Keyword(s):  
Severe Asthma ◽  
Life Support ◽  
Extracorporeal Life Support

scholarly journals ECMO em Recém-nascidos com Hérnia Diafragmática Congénita: A Experiência de um Centro de Referência de ECMO em Portugal

2020 ◽  
Vol 33 (12) ◽  
pp. 819
Author(s):  
Mariana Miranda ◽  
Francisco Abecasis ◽  
Sofia Almeida ◽  
Erica Torres ◽  
Leonor Boto ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Ventilatory Support ◽  
Pediatric Intensive Care ◽  
Cycle Duration ◽  
Extracorporeal Life Support Organization ◽  
Support Organization ◽  
Technological Advances

Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia.Material and Methods: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019. Data collection using the Extracorporeal Life Support Organization registration and unit data base.Results: Fourteen newborns were included, all with left congenital diaphragmatic hernia, in a total of 15 venoarterial ECMO cycles. The median gestational age was 38 weeks and the median birth weight was 2.950 kg. Surgical repair was performed before entry into ECMO in six, during in seven and after in one newborn. The average age at placement was 3.3 days and the median cycle duration was 16 days. Prior to ECMO, all newborns had severe hypoxemia and acidosis despite optimized ventilatory support, with nitric oxide and inotropic therapy. After 24 hours on ECMO, there was correction of acidosis, improvement of oxygenation and hemodynamic stability. All cycles presented mechanical complications, the most frequent being the presence of clots in the circuit. The most frequent physiological complications were hemorrhagic and embolic (three newborns suffered an ischemic stroke during the cycle). Five newborns (35.7%) died, all associated with complications (two strokes, two massive bleedings and one accidental decannulation). Chronic lung disease, poor weight gain and psychomotor developmental delay were the most frequent long-term morbidities.Discussion: Despite technological advances in respiratory care and improved safety of the ECMO technique, the management of these newborns is complex and there are still several open questions, including the appropriate selection of patients, the best approach and time for surgical correction, and the treatment of pulmonary hypertension in the presence of persistent fetal shunts.Conclusion: Survival rate was higher than reported in 2017 Extracorporeal Life Support Organization report (64% versus 50%). Mechanical and hemorrhagic complications were very frequent.

Approach to the Patient with Acute Respiratory Failure

2016 ◽  
Author(s):  
Eddy Fan ◽  
Alice Vendramin
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Life Support ◽  
Ventilatory Support ◽  
Lung Protective Ventilation ◽  
Positive Pressure ◽  
Hypoxemic Respiratory Failure ◽  
Arterial Blood ◽  
Common Causes

Acute respiratory failure (ARF) is a common reason for admission to the intensive care unit (ICU), and is associated with significant morbidity and mortality. Failure of one or more components of the respiratory system can lead to hypoxemia, hypercabia, or both. Initial evaluation of patients with ARF should include physical examination, chest imaging, and arterial blood gases (ABG) sampling. As ARF is often a life-threatening emergency, a patient’s oxygenation and ventilation will need to be supported at the same time that diagnostic and therapeutic interventions are planned. The priorities for early treatment are essentially those of basic life support: airway and breathing. The first step is to assess a patient’s airway and ascertain that it is patent. This is followed by efforts to support both oxygenation and ventilation. This can include non-invasive or invasive mechanical ventilatory support. As with all interventions, there are risks inherent in the use of mechanical ventilation, which may be minimized by the use of lung protective ventilation (i.e., with low tidal volumes and airway pressures). Finally, due to the potential complications associated with mechanical ventilation, it is important to regularly assess whether a patient continues to require the assistance of the ventilator, and to liberate patients from mechanical ventilation at the earliest opportunity when clinically safe and feasible to do so. Figures depict pressure-time curve. Tables list the clinical causes of hypoxemic respiratory failure, oxygen delivery devices, indications for noninvasive positive pressure support, common causes of abnormal respiratory mechanics, and common causes of acute respiratory distress syndrome (ARDS). This review contains 2 highly rendered figures, 5 tables, and 86 references.

Acute respiratory failure

2020 ◽  
pp. 287-294
Author(s):  
Martin Balik
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Ventricular Function ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Rapid Assessment ◽  
Ventilatory Support ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Subsequent Withdrawal

Acute respiratory failure is a common reason for admission to the intensive care ward and it is frequently accompanied by haemodynamic instability. Obligatory assessments in every patient should include left ventricular function, left atrial and left ventricular filling pressures in addition to an assessment of right ventricular function and the pulmonary circulation. A systematic echo protocol is warranted to judiciously decide on treatment strategy, including optimization of the patient’s preload, contractility, heart rate, and afterload. This allows for a more effective management of the respiratory disequilibrium, which can continue to be monitored by ultrasound examination. Monitoring of lung parenchyma and pleural space adds to the echo derived information and assist the physician in deciding on an optimal ventilation strategy, need for bronchoscopy, pleural drainage, and patient positioning including proning. The appropriateness of prescribed therapy for the acute respiratory failure can then be monitored by echocardiography and lung ultrasonography to optimize pulmonary gas exchange without haemodynamic deterioration and conversely improve the patient’s haemodynamic status without adding an unnecessary burden onto the respiratory system. After respiratory failure responds to treatment, echocardiography can then assist with the weaning and subsequent withdrawal of mechanical ventilatory support. Where respiratory failure does not respond to conventional measures, a rapid assessment with echocardiography and chest ultrasound helps to decide whether to proceed to extracorporeal life support and, if adopted, its optimal configuration.

scholarly journals Rituximab Induced Pulmonary Edema Managed with Extracorporeal Life Support

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Jacob R. Miller ◽  
Warren Isakow ◽  
Muhammad F. Masood ◽  
Patrick Aguilar ◽  
Kristen M. Sanfilippo ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Edema ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Respiratory Acidosis ◽  
High Dose ◽  
Thrombocytopenic Purpura ◽  
Cardiorespiratory Failure ◽  
Severe Pulmonary Edema

Though rare, rituximab has been reported to induce severe pulmonary edema. We describe the first report of ECLS utilization for this indication. A 31-year-old female with severe thrombotic thrombocytopenic purpura developed florid pulmonary edema after rituximab infusion. Despite advanced ventilatory settings, she developed severe respiratory acidosis and remained hypoxemic with a significant vasopressor requirement. Since her pulmonary insult was likely transient, ECLS was considered. Due to combined cardiorespiratory failure, she received support with peripheral venoarterial ECLS. During her ECLS course, she received daily plasmapheresis and high dose steroids. Her pulmonary function recovered and she was decannulated after 8 days. She was discharged after 23 days without residual sequelae.

scholarly journals Volatile Agents to Avoid Ventilating Asthmatics

2003 ◽  
Vol 31 (2) ◽  
pp. 208-210 ◽  
Author(s):  
G. Baigel
Keyword(s):  
Mechanical Ventilation ◽  
Tracheal Intubation ◽  
Medical Treatment ◽  
Severe Asthma ◽  
Initial Response ◽  
Acute Severe Asthma ◽  
Inhalational Agent ◽  
The Face ◽  
Spontaneously Breathing ◽  
Volatile Agents

The management of six awake, spontaneously breathing patients with acute severe asthma who responded to a subanesthetic dose of an inhalational agent is described. All of these patients were on maximal medical treatment, the next intervention likely to be tracheal intubation and mechanical ventilation in the face of further deterioration. All six patients initially responded dramatically, although one required mechanical ventilation after initial response.

scholarly journals Early administration of venovenous extracorporeal life support for status asthmaticus during anaesthetic induction: case report and literature review

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Won Ho Chang
Keyword(s):  
Status Asthmaticus ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Anaesthetic Induction ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Stanford Type B

AbstractHere we report a case of a 40-year-old man who visited the emergency room with severe chest pain. He showed a Stanford type B aortic dissection on chest-computed tomography. Despite medical treatment and malperfusion of lower extremities, acute renal failure developed; hence thoracic endovascular aortic repair (TEVAR) was considered under general anaesthesia. After endotracheal intubation, ventilation with low tidal volume required high inspiratory airway pressure. An arterial blood gas analysis showed PaCO2 of 61.8mmHg and PaO2 of 26.4mmHg, indicating a status asthmaticus of hypoxaemia and hypercarbia, which did not respond to bronchodilator or mechanical ventilation. Impending cardiac arrest was treated using venovenous extracorporeal life support, which was administered by percutaneous femoral cannulation. Surgical procedure was completed without any complications. Extracorporeal life support was weaned at one day after the operation. The patient was discharged without any complications.

scholarly journals The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock

2019 ◽  
Vol 7 (11) ◽  
pp. 1768-1773
Author(s):  
Mohamed Abouelwafa ◽  
Waheed Radwan ◽  
Alia Abdelfattah ◽  
Akram Abdelbary ◽  
Mohamed Khaled ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Serum Lactate ◽  
Base Deficit ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Arterial Blood ◽  
Va Ecmo

BACKGROUND: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.AIM: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.MATERIAL AND METHODS: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support. RESULTS: The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005).CONCLUSIONS: We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.

Approach to the Patient with Acute Respiratory Failure

2018 ◽  
Author(s):  
Eddy Fan ◽  
Alice Vendramin
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Life Support ◽  
Ventilatory Support ◽  
Lung Protective Ventilation ◽  
Positive Pressure ◽  
Hypoxemic Respiratory Failure ◽  
Arterial Blood ◽  
Common Causes

Acute respiratory failure (ARF) is a common reason for admission to the intensive care unit (ICU), and is associated with significant morbidity and mortality. Failure of one or more components of the respiratory system can lead to hypoxemia, hypercabia, or both. Initial evaluation of patients with ARF should include physical examination, chest imaging, and arterial blood gases (ABG) sampling. As ARF is often a life-threatening emergency, a patient’s oxygenation and ventilation will need to be supported at the same time that diagnostic and therapeutic interventions are planned. The priorities for early treatment are essentially those of basic life support: airway and breathing. The first step is to assess a patient’s airway and ascertain that it is patent. This is followed by efforts to support both oxygenation and ventilation. This can include non-invasive or invasive mechanical ventilatory support. As with all interventions, there are risks inherent in the use of mechanical ventilation, which may be minimized by the use of lung protective ventilation (i.e., with low tidal volumes and airway pressures). Finally, due to the potential complications associated with mechanical ventilation, it is important to regularly assess whether a patient continues to require the assistance of the ventilator, and to liberate patients from mechanical ventilation at the earliest opportunity when clinically safe and feasible to do so. Figures depict pressure-time curve. Tables list the clinical causes of hypoxemic respiratory failure, oxygen delivery devices, indications for noninvasive positive pressure support, common causes of abnormal respiratory mechanics, and common causes of acute respiratory distress syndrome (ARDS). This review contains 2 highly rendered figures, 5 tables, and 86 references.

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