scholarly journals Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Ghiani ◽  
Matthias Hansen ◽  
Konstantinos Tsitouras ◽  
Claus Neurohr
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Practical Knowledge ◽  
Left Lung ◽  
Clinical Problem ◽  
Lung Protective Ventilation ◽  
Air Leak ◽  
Membrane Oxygenation ◽  
Protective Ventilation Strategy ◽  
Persistent Air Leak

Prolonged pulmonary air leak (PAL) is a common clinical problem, associated with significant morbidity and mortality. There are numerous reports of treatment of PAL using endobronchial valves (EBV) in respiratory stable patients, but only few reports on critically ill patients, and there is virtually no practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), treated with veno-venous extracorporeal membrane oxygenation (vvECMO). We describe a case where EBV placement was performed in a patient with ARDS and PAL, treated with mechanical ventilation and vvECMO. Despite a lung protective ventilation strategy, a persistent air leak along with a large left-sided pneumothorax was observed. After bronchoscopic localisation of the fistula, two endobronchial valves were inserted into the left upper lobe, leading to an immediate decrease in the air flow and reexpansion of the left lung. During the following two weeks, the patient was weaned from vvECMO, and after another three weeks, complete liberation from mechanical ventilation was accomplished. EBV placement seems to be a safe method even in the presence of coagulopathy and may facilitate mechanical ventilation and weaning from vvECMO in patients with ARDS and PAL.

Favourable outcome after prolonged veno-venous extracorporeal membrane oxygenation (V-V ECMO) support for Pneumocystis jirovecii pneumonia in a renal transplant recipient

2021 ◽  
Vol 14 (4) ◽  
pp. e240004
Author(s):  
Daniel Kleinloog ◽  
Jacinta Maas ◽  
Jorge Lopez Matta ◽  
Carlos Elzo Kraemer
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Favourable Outcome ◽  
Pneumocystis Jirovecii ◽  
Lung Protective Ventilation ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Partial Recovery ◽  
Ventilation Strategy ◽  
Membrane Oxygenation ◽  
Protective Ventilation Strategy ◽  
History Of

A 27-year-old man, with a history of renal transplantation, presented with acute kidney failure and Pneumocystis jirovecii pneumonia. The patient developed severe acute respiratory failure and required support by veno-venous extracorporeal membrane oxygenation for a total of 59 days. During this period, the patient had extremely low tidal volumes using a lung protective ventilation strategy and intermittent prone positioning was used to optimise oxygenation. There was full recovery of pulmonary and partial recovery of renal function.

scholarly journals Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Zhongheng Zhang ◽  
Wan-Jie Gu ◽  
Kun Chen ◽  
Hongying Ni
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Large Body ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Severe Respiratory Failure ◽  
Membrane Oxygenation ◽  
Number Of Patients ◽  
Protective Ventilation Strategy

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

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

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.

scholarly journals Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation

2018 ◽  
Vol 63 (9) ◽  
pp. 1180-1188 ◽  
Author(s):  
Madhavi Parekh ◽  
Darryl Abrams ◽  
Daniel Brodie ◽  
Natalie H Yip
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Membrane Oxygenation

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

PEDIATRICS ◽  
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.

Pneumopericardium in the neonate: a case report

Perfusion ◽  
2019 ◽  
Vol 35 (4) ◽  
pp. 360-362
Author(s):  
Jasmeet Kataria-Hale ◽  
Caraciolo J Fernandes ◽  
Michael E Speer
Keyword(s):  
Case Report ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Tamponade ◽  
Term Infant ◽  
Spontaneous Resolution ◽  
Air Leak ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation

A term infant with cardiorespiratory failure treated with veno-venous extracorporeal membrane oxygenation developed pneumopericardium with cardiac tamponade while on the extracorporeal membrane oxygenation circuit. The patient was converted to veno-arterial extracorporeal membrane oxygenation and managed conservatively with spontaneous resolution of the air leak.

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