Step Down From Extra Corporeal Membrane Oxygenation (ECMO) To Extra Corporeal Carbon Dioxide Removal (ECCO2R) In Severe Persistent Acute Respiratory Distress Syndrome (ARDS)

2011 ◽  
Author(s):  
David Salman ◽  
Jeremy J. Cordingley ◽  
Susanna Price ◽  
Michael Dusmet ◽  
Simon J. Finney ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Carbon Dioxide Removal ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Step Down

scholarly journals Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome

2018 ◽  
Vol 20 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Hariharan Regunath ◽  
Nathanial Moulton ◽  
Daniel Woolery ◽  
Mohammed Alnijoumi ◽  
Troy Whitacre ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Carbon Dioxide Removal ◽  
Driving Pressure ◽  
Protective Mechanical Ventilation

Background Tidal hyperinflation can still occur with mechanical ventilation using low tidal volume (LVT) (6 mL/kg predicted body weight (PBW)) in acute respiratory distress syndrome (ARDS), despite a well-demonstrated reduction in mortality. Methods Retrospective chart review from August 2012 to October 2014. Inclusion: Age >18years, PaO2/FiO2<200 with bilateral pulmonary infiltrates, absent heart failure, and ultra-protective mechanical ventilation (UPMV) defined as tidal volume (VT) <6 mL/kg PBW. Exclusion: UPMV use for <24 h. Demographics, admission Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, arterial blood gas, serum bicarbonate, ventilator parameters for pre-, during, and post-UPMV periods including modes, VT, peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure, etc. were gathered. We compared lab and ventilator data for pre-, during, and post-UPMV periods. Results Fifteen patients (male:female = 7:8, age 42.13 ± 11.29 years) satisfied criteria, APACHEII 20.6 ± 7.1, mean days in intensive care unit and hospitalization were 18.5 ± 8.85 and 20.81 ± 9.78 days, 9 (60%) received paralysis and 7 (46.67%) required inotropes. Eleven patients had echocardiogram, 7 (63.64%) demonstrated right ventricular volume or pressure overload. Eleven patients (73.33%) survived. During-UPMV, VT ranged 2–5 mL/kg PBW(3.99 ± 0.73), the arterial partial pressure of carbon dioxide (PaCO2) was higher than pre-UPMV values (84.81 ± 18.95 cmH2O vs. 69.16 ± 33.09 cmH2O), but pH was comparable and none received extracorporeal carbon dioxide removal (ECCO2-R). The positive end-expiratory pressure (14.18 ± 7.56 vs. 12.31 ± 6.84 cmH2O), PIP (38.21 ± 12.89 vs. 32.59 ± 9.88), and mean airway pressures (19.98 ± 7.61 vs. 17.48 ± 6.7 cm H2O) were higher during UPMV, but Pplat and PaO2/FiO2 were comparable during- and pre-UPMV. Driving pressure was observed to be higher in those who died than who survived (24.18 ± 12.36 vs. 13.42 ± 3.25). Conclusion UPMV alone may be a safe alternative option for ARDS patients in centers without ECCO2-R.

scholarly journals Early veno-venous Extra Corporeal Membrane Oxygenation with prone positioning in the treatment of severe Acute Respiratory Distress syndrome in a pediatric patient: a case report

2019 ◽  
Vol 6 (4) ◽  
pp. 1743
Author(s):  
Md Nawad Azam ◽  
Senthil Kumar S. P.
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Adult Population ◽  
Age Group ◽  
Prone Positioning ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Aim of the study was to discuss effectiveness and outcome of Extra Corporeal Membrane Oxygenation (ECMO) therapy with prone positioning while on ECMO in a child with severe Acute Respiratory Distress Syndrome (ARDS). Veno-venous ECMO (VV-ECMO) and prone position on ECMO are relatively newer modalities of treatment in severe ARDS in pediatric age group and to our experience very few cases has been reported in paediatric age group. A 5 year old male child presented with fever with respiratory distress. He deteriorated in next 48 hrs leading to severe hypoxemia with ARDS following which he was put on conventional ventilation. In view of worsening critical lung parameters, veno-venous ECMO was initiated. Child had persistent hypoxemia inspite on high positive end expiaratory pressure (PEEP), adequate flow and adequate Post oxygenator PO2. Recirculation and other possible causes were excluded. Prone positioning (PP) was done for 8 hrs a day with chest physiotherapy while on ECMO. Patient showed considerable improvement in next few days and ECMO was weaned on day 7 and child was discharged on day 16 with good lung recovery. Although studies on VV-ECMO with PP has proven effectiveness in severe ARDS in adult population, overall studies in paediatric ARDS are very limited. Prone positioning on ECMO may decrease duration of ECMO support. Prone positioning on VV ECMO is safe and can be considered in Persistent hypoxemia with poor respiratory compliance.

Successful use of Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricular support for acute respiratory distress syndrome in an adolescent with complex congenital heart disease

Perfusion ◽  
2020 ◽  
pp. 026765912092388
Author(s):  
Niranjan Vijayakumar ◽  
Aditya Badheka ◽  
Madhuradhar Chegondi ◽  
Daniel Mclennan
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Left Ventricular ◽  
Extra Corporeal Membrane Oxygenation ◽  
Assist Device ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Left Ventricular Assist

Rescuing patients with the development of acute respiratory distress syndrome and right heart failure after left ventricular assist device placement remains a challenge in patients with congenital heart disease. TandemLife Protek Duo (TandemLife, Pittsburg, PA) is a double-lumen cannula introduced via the internal jugular vein that can provide veno-venous extra-corporeal membrane oxygenation and right heart support. To our knowledge, we report the first case of successfully using the TandemLife Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricle support in an adolescent male with an existing right ventricle-pulmonary artery conduit and the melody pulmonary valve who developed severe acute respiratory distress syndrome after the placement of left ventricular assist device. The stability of the cannula enabled minimal recirculation-related hypoxia events, early mobilization, and ambulation. Our patient was discharged home after lung recovery and currently awaiting a heart transplant.

Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome

2015 ◽  
Vol 122 (3) ◽  
pp. 631-646 ◽  
Author(s):  
Andreas Güldner ◽  
Thomas Kiss ◽  
Thomas Bluth ◽  
Christopher Uhlig ◽  
Anja Braune ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Spontaneous Breathing ◽  
Distress Syndrome ◽  
Carbon Dioxide Removal ◽  
Intrapulmonary Shunt ◽  
Extracorporeal Carbon Dioxide Removal

Abstract Background: To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. Methods: Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. Results: The authors found that: (1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. Conclusions: In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation.

Sign in / Sign up

Export Citation Format

Share Document