Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation

2020 ◽  
pp. 039139882094887
Author(s):  
George Ntoumenopoulos ◽  
Hergen Buscher ◽  
Sean Scott
Keyword(s):  
Gas Flow ◽  
Work Of Breathing ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Hospital Length Of Stay ◽  
Lung Injury Score ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Dynamic Lung Compliance ◽  
Vv Ecmo

Decisions on weaning from veno-venous extra-corporeal membrane oxygenation (VV-ECMO) requires the ability to maintain adequate gas exchange and work of breathing with reductions in ECMO pump flow and fresh gas flow. Testing of the readiness to wean the patient from ECMO however may vary dependent upon local protocols and clinical judgment. This study sought to validate the use of the LUS-score during VV-ECMO against the changes in chest x-ray infiltrates, dynamic lung compliance (CLdyn) and VV-ECMO settings (as standard measures of native lung function and the level of ECMO support) during the ECMO cycle. This prospective cohort study of 10 patients on VV-ECMO compared the LUS score (range 0–36) within 48-h, day 5 and day 10 of commencement of ECMO (or on the day of ECMO decannulation) to dynamic lung compliance, Murray Lung Injury Score and ECMO settings. Seven Male and three Female patients were included (average age 37 years (SD 14.8) and weight 71 Kg (SD 16.9). Median (IQR) duration of ECMO, ICU and hospital length of stay was 7.5 days (5.2–19.0), 12.5 days (8.5–22.7), 19.0 days (12.1– 36.1), respectively. There was a strong negative association between LUS-score and dynamic lung compliance (rs(33) = –0.66, p < .001) providing some validation on the use of the LUS score as a potential surrogate measure of lung aeration and lung mechanics during VV-ECMO weaning.

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.

Changes in lung mechanics induced by acute isocapnic hypoxia

1977 ◽  
Vol 42 (3) ◽  
pp. 413-419 ◽  
Author(s):  
N. A. Saunders ◽  
M. F. Betts ◽  
L. D. Pengelly ◽  
A. S. Rebuck
Keyword(s):  
Total Lung Capacity ◽  
Lung Compliance ◽  
Specific Conductance ◽  
Lung Mechanics ◽  
Recoil Pressure ◽  
Lung Capacity ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Residual Capacity ◽  
Dynamic Lung Compliance

We measured lung mechanics in seven healthy males during acute isocapnic hypoxia (PAO2 = 40–50 Torr; PACO2 = 38–42 Torr). Hypoxia was accompanied by increases in total lung capacity (mean increase +/- SD; 0.40 +/- 0.24 liters; P less than 0.005) functional residual capacity (0.34 +/- 0.25 liters; P less than 0.01) and residual volume (0.56 +/- 0.44 liters; P less than 0.02) in all subjects. Specific conductance of the lung decreased during hypoxia (P less than 0.02). The static deflation pressure-volume curve of the lung was shifted upward during hypoxia in all subjects. Resting end-expiratory recoil pressure of the lung was slightly, but not significantly lower during hypoxtic expiratory lung compliance was greater during hypoxia (0.39 +/- 0.04 l/cmH2O) than control measurements (0.31 +/- 0.05 l/cmH2O; P less than 0.005). No change was noted in dynamic lung compliance. All changes in lung mechanics were reversed within three minutes of reoxygenation. We conclude that acute isocapnic hypoxia increases total lung capacity in man and suggest that this may be due to the effect of hypoxia on the airways and pulmonary circulation.

scholarly journals Mechanisms of Orthopnoea in Patients with Advanced COPD

2020 ◽  
pp. 2000754
Author(s):  
Amany F. Elbehairy ◽  
Azmy Faisal ◽  
Hannah McIsaac ◽  
Nicolle J. Domnik ◽  
Kathryn M. Milne ◽  
...  
Keyword(s):  
Supine Position ◽  
Minute Ventilation ◽  
Pulmonary Function Tests ◽  
Work Of Breathing ◽  
Airflow Obstruction ◽  
Lung Compliance ◽  
Chronic Obstructive ◽  
Inspiratory Muscles ◽  
Elastic Loading ◽  
Dynamic Lung Compliance

Many patients with severe chronic obstructive pulmonary disease (COPD) report unpleasant respiratory sensation at rest, further amplified by adoption of supine position (orthopnoea). The mechanisms of this acute symptomatic deterioration are poorly understood.16 patients with advanced COPD and history of orthopnoea and 16 age- and sex-matched healthy controls (CTRL) underwent pulmonary function tests and detailed sensory-mechanical measurements including inspiratory neural drive (IND, diaphragm electromyography), oesophageal and gastric pressures in sitting and supine positions.Patients had severe airflow obstruction (FEV1: 40±18%predicted) and lung hyperinflation. Regardless of the position, patients had lower inspiratory capacity (IC) and higher IND for a given tidal volume (i.e. greater neuromechanical dissociation (NMD)), higher intensity of breathing discomfort, minute ventilation (⩒E) and breathing frequency (Fb) compared with CTRL (all p<0.05). In supine position in CTRL (versus sitting erect): IC increased (by 0.48L) with a small drop in ⩒E mainly due to reduced Fb (all p<0.05). By contrast, patients’ IC remained unaltered, but dynamic lung compliance decreased (p<0.05) in the supine position. Breathing discomfort, inspiratory work of breathing, inspiratory effort, IND, NMD and neuro-ventilatory uncoupling all increased in COPD in the supine position (p<0.05), but not in CTRL. Orthopnoea was associated with acute changes in IND (r=0.65, p=0.01), neuro-ventilatory uncoupling (r=0.76, p=0.001) and NMD (r=0.73, p=0.002).In COPD, onset of orthopnoea coincided with an abrupt increase in elastic loading of the inspiratory muscles in recumbency in association with increased IND and greater neuromechanical dissociation of the respiratory system.

Acute effects of atrial natriuretic peptide on lung mechanics and hemodynamics in awake sheep

1990 ◽  
Vol 69 (2) ◽  
pp. 728-733 ◽  
Author(s):  
M. R. Banerjee ◽  
J. H. Newman
Keyword(s):  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Pulmonary Arteries ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Base Line ◽  
Hemodynamic Effects ◽  
Airway Response ◽  
Dynamic Lung Compliance ◽  
Atrial Natriuretic

The purpose of this study was to measure airway and hemodynamic effects of atrial natriuretic peptide (ANP) and its efficacy in counteracting the changes in lung mechanics that occur with aerosol histamine and carbachol. Synthetic human alpha-ANP was injected into the pulmonary arteries of awake sheep chronically instrumented for measurement of lung mechanics and hemodynamics (n = 7). Base-line dynamic lung compliance (Cdyn) and pulmonary resistance (RL) did not change after ANP injection. On separate days, the dose required to reduce Cdyn to 65% of base line (ED65Cdyn) to progressive doses of aerosol histamine and the dose required to increase RL by 100% of the base-line values (ED200RL) to progressive doses of aerosol carbachol were determined. ANP was given as bolus injections of 1, 5, and 10 micrograms/kg 3 min after either the ED65Cdyn or ED200RL doses of histamine and carbachol, respectively, and the airway response was monitored for 10 min. ANP significantly reversed the rise in RL after carbachol administration (n = 10). This action of ANP was not altered by cyclooxygenase inhibition with ibuprofen. ANP did not reverse the reduction in Cdyn caused by either histamine (n = 7) or carbachol. The bronchodilating effect of ANP appears to be more prominent in the larger central airways than in the peripheral airways. The hemodynamic effects of ANP were similar to those reported by others. Heart rate and cardiac output had a biphasic response, with an initial rise followed by a drop below the base line. Systemic arterial and left atrial pressures decreased significantly. Pulmonary arterial pressure did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of stability of the respiratory system in preterm infants

1988 ◽  
Vol 65 (1) ◽  
pp. 441-444 ◽  
Author(s):  
G. P. Heldt
Keyword(s):  
Chest Wall ◽  
Preterm Infants ◽  
Pulmonary Ventilation ◽  
Lung Compliance ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Diaphragmatic Function ◽  
Postconceptional Age ◽  
Intraesophageal Pressure ◽  
Dynamic Lung Compliance

Chest wall distortion leads to increased minute volume displacement of the diaphragm (MVDD) and diaphragmatic work (DW) in preterm infants. Lung mechanics, MVDD, and DW were measured at weekly intervals in six preterm infants between 29 and 36 wk postconceptional age. Over the period of study, MVDD and DW decreased significantly, whereas dynamic lung compliance consistently increased. There was no consistent change in the pulmonary ventilation, total pulmonary resistance, the work performed on the lungs, or the change in intraesophageal pressure with tidal breathing. The improvement in the stability of the chest wall, as indicated by the change in these dynamic measurements of diaphragmatic function, parallels the decrease in static chest wall compliance and the clinical course of the resolution of apnea of prematurity.

scholarly journals Changes in dynamic lung mechanics after lung volume reduction coil treatment of severe emphysema

Thorax ◽  
2017 ◽  
Vol 73 (6) ◽  
pp. 584-586 ◽  
Author(s):  
Demosthenes Makris ◽  
Sylvie Leroy ◽  
Johana Pradelli ◽  
Jonathan Benzaquen ◽  
Hervé Guenard ◽  
...  
Keyword(s):  
Lung Volume ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Dynamic Hyperinflation ◽  
Positive End Expiratory Pressure ◽  
Lung Volume Reduction ◽  
Inspiratory Capacity ◽  
Endurance Time ◽  
Significant Attenuation ◽  
Dynamic Lung Compliance

We assessed the relationships between changes in lung compliance, lung volumes and dynamic hyperinflation in patients with emphysema who underwent bronchoscopic treatment with nitinol coils (coil treatment) (n=11) or received usual care (UC) (n=11). Compared with UC, coil treatment resulted in decreased dynamic lung compliance (CLdyn) (p=0.03) and increased endurance time (p=0.010). The change in CLdyn was associated with significant improvement in FEV1 and FVC, with reduction in residual volume and intrinsic positive end-expiratory pressure, and with increased inspiratory capacity at rest/and at exercise. The increase in end-expiratory lung volume (EELV) during exercise (EELVdyn-ch=EELVisotime EELVrest) demonstrated significant attenuation after coil treatment (p=0.02).

scholarly journals Effective and Safe Use of Glucocorticosteroids for Rescue of Late ARDS

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Paolo Diana ◽  
Dustin T. Money ◽  
Michael G. Gelvin ◽  
Nadia Lunardi
Keyword(s):  
Marked Improvement ◽  
Low Dose ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Corticosteroid Treatment ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Extra Corporeal Membrane Oxygenation ◽  
Rescue Treatment ◽  
Refractory Hypoxemia

We describe a case of severe refractory hypoxemia requiring prolonged extra corporeal membrane oxygenation (ECMO) support in a case of postpartum acute respiratory distress syndrome (ARDS). The clinical course was marked by persistently poor lung compliance and several complications of ECMO, that is, significant hemolysis, hemothorax, and intracranial bleeding. We report marked improvement of lung mechanics and respiratory function, leading to accelerated separation from ECMO, following rescue administration of low dose methylprednisolone 24 days after the onset of ARDS. Corticosteroid treatment was safe and well tolerated. In contrast with the conclusions of the 2006 ARDS Network trial, our report establishes a case in support of the use of low dose methylprednisolone as a safe and effective rescue treatment option in selected subsets of patients with nonresolving ARDS.

scholarly journals Ventilation and respiration mechanics in patients with chronic obstructive pulmonary disease in different body positions

2019 ◽  
Vol 18 (3) ◽  
pp. 37-45
Author(s):  
Al. Ju. Dish ◽  
An. Ju. Dish ◽  
T. S. Ageeva ◽  
A. L. Karzilov ◽  
A. V. Teteneva ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Body Position ◽  
Work Of Breathing ◽  
Left Lung ◽  
Lung Compliance ◽  
The Body ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Dynamic Lung Compliance

The aim of this work was to study changes in mechanical lung properties in cases of COPD in general and in different zones depending on the body position.Materials and methods. The research was performed in 37 patients with chronic obstructive pulmonary disease (COPD) in the vertical and horizontal positions (VP and HP).Results. The analysis of integral respiration mechanics has revealed a reduction in dynamic lung compliance and an increase in total non-elastic lung resistance during expiration (TNRexp) in HP vs. VP. At the same time, despite the increase in TNRexp in HP, the total work of breathing did not increase. Unlike healthy individuals, the COPD patients were characterized by the absence of differences in regional mechanical properties in both VP and HP. There were no differences in the respiration mechanics of the left lung, and the zones of the right lung only differed in the parameters of regional non-elastic work of breathing (NWBr ) that was increasing from top downwards: the indicators of NWBr during expiration and NWBr in the lower zone were higher as opposed to those of the upper zone in VP. As for HP, NWBr during inspiration, NWBr during expiration and NWBr were higher.Conclusion. The data obtained contradict the prevailing opinion about an escalation in regional differences in ventilation and respiration mechanics under the influence of emerging focal and diffuse inflammatorysclerotic pathological changes in lungs and emphysema. 

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