scholarly journals Usefulness of Lung Ultrasound for early detection of Hospital-Acquired Pneumonia in Patients on Veno-Arterial Extra Corporeal Membrane Oxygenation.

2021 ◽  
Author(s):  
Jean Pasqueron ◽  
Pauline Dureau ◽  
Gauthier Arcile ◽  
Baptiste Duceau ◽  
Geoffroy Hariri ◽  
...  
Keyword(s):  
Early Detection ◽  
Observational Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Chest Radiography ◽  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Intrapulmonary Shunt ◽  
Membrane Oxygenation ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract BACKGROUND: Hospital-Acquired Pneumonia (HAP) is the most common and severe complication in patients treated with veno-arterial extracorporeal membrane oxygenation (ECMO). HAP early detection is challenging but crucial for improving clinical outcomes. We conduct an observational study to assess whether Lung Ultrasound (LUS) improves detection of HAP in in patients treated with veno-arterial ECMO.METHODS: We conducted a single-center, prospective, observational study including adult patients receiving veno-arterial extracorporeal membrane oxygenation assistance that presented acute respiratory failure. Bedside LUS and chest radiography were performed at the time of inclusion when HAP was suspected. Then the patients were independently assessed for HAP including microbiological evidence. The sonographic features of HAP on veno-arterial ECMO were determined. We then compared the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), including bio-clinical data and the Doppler detection of intrapulmonary shunt, to the sCPIS, including bio-clinical and chest radiological data for detection of HAP. RESULTS: We included 70 patients, of which 44 (63%) were independently diagnosed with hospital-acquired pneumonia. LUS examination revealed that Doppler intrapulmonary shunt (P=0.0000043) and dynamic air bronchogram (P=0.00024) were the most frequent hospital-acquired pneumonia-related signs. The LUS-sCPIS (Area under the curve = 0.77) yielded significantly better results than the sCPIS (Area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiology were not discriminating for the hospital-acquired pneumonia diagnosis.CONCLUSION: The diagnosis of hospital-acquired pneumonia is a daily challenge for the clinician managing patients on veno-arterial ECMO . Lung ultrasound is more powerful than chest radiography and can be a valuable aid as initial imaging modality for the diagnosis of pneumonia. Intrapulmonary shunt detected using color Doppler and dynamic air bronchogram appear to be particularly discriminating for the diagnosis of hospital-acquired pneumonia.CLINICAL TRIAL REGSITRATION: NA

scholarly journals Community versus hospital-acquired pneumonia in patients requiring extracorporeal membrane oxygenation

2019 ◽  
Vol 13 ◽  
pp. 175346661882103 ◽  
Author(s):  
Chul Park ◽  
Soo Jin Na ◽  
Chi Ryang Chung ◽  
Yang Hyun Cho ◽  
Gee Young Suh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Bacterial Pneumonia ◽  
Distress Syndrome ◽  
Resistant Bacteria ◽  
Membrane Oxygenation ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Bacterial pneumonia is a major cause of acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) support. However, it is unknown whether the type of pneumonia, community-acquired pneumonia (CAP) versus hospital-acquired pneumonia (HAP), should be considered when predicting outcomes for ARDS patients treated with ECMO. Methods: We divided a sample of adult patients receiving ECMO for acute respiratory distress syndrome caused by bacterial pneumonia between January 2012 and December 2016 into CAP ( n = 21) and HAP ( n = 35) groups and compared clinical and bacteriological characteristics and outcomes. Results: The median acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 22 and 8, respectively, in the CAP and HAP groups. The most commonly identified organism in the CAP group was Streptococcus pneumonia ( n = 12, 57.1%), while Acinectobacter baumanii was the most commonly identified in the HAP group ( n = 13, 37.1%). However, the incidence of multidrug resistant bacteria was not different between groups (57.1% versus 74.3%, p = 0.125). Of the 56 patients in the study, 26 were successfully weaned from ECMO, and 20 were discharged from the hospital. There were no significant differences in ECMO weaning rate (47.6% versus 45.7%, p > 0.999) or survival to discharge rate (33.3% versus 37.1%, p > 0.999) between the two groups. The 30-day and 90-day mortality rates were also similar. Conclusion: Patients with CAP and HAP who received ECMO for respiratory support had similar characteristics and clinical outcomes.

Radiographic appearance of extracorporeal membrane oxygenations versus left ventricular assist device

2021 ◽  
Vol 31 (5) ◽  
pp. 831-832
Author(s):  
Phillip M Mackie ◽  
Giles J Peek ◽  
Jeffrey P Jacobs ◽  
Mark S Bleiweis
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Chest Radiography ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Radiographic Appearance ◽  
Membrane Oxygenation ◽  
Left Ventricular Assist

AbstractChest radiography compares left ventricular decompression in the same patient supported with extracorporeal membrane oxygenation with atrial septal fenestration and subsequently supported with left ventricular assist device with apical cannulation.

Abstract 210: Effects of Indication for Veno-Arterial Extracorporeal Membrane Oxygenation on Predictive Value of Save Score

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Marinos Kosmopoulos ◽  
Jason A Bartos ◽  
Demetris Yannopoulos
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Roc Curve ◽  
Predictive Value ◽  
Prediction Models ◽  
External Validation ◽  
Area Under The Curve ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Survival Estimation ◽  
Va Ecmo

Introduction: Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) has emerged as a prominent tool for management of patients with Inability to Wean Off Cardiopulmonary Bypass (IWOCB), extracorporeal cardiopulmonary resuscitation (eCPR) or refractory cardiogenic shock (RCS). The high mortality that is still associated with these diseases urges for the development of reliable prediction models for mortality after cannulation. Survival After VA ECMO (SAVE) Score consists one of the most widely used prediction tools and the only model with external validation. However, its predictive value is still under debate. Hypothesis: Whether VA ECMO indication affects the predictive value of SAVE Score. Methods: 317 patients treated with VA ECMO in a quaternary center (n= 52 for IWOCB, n=179 for eCPR and n=86 for RCS) were retrospectively assessed for differences in SAVE Score and their primary outcomes. The Receiver Operating Characteristic (ROC) curve for SAVE Score and mortality was calculated separately for each VA ECMO indication. Results: The three groups had significant differences in SAVE Score (p<0.01) without significant differences in mortality (p=0.176). ROC Curve calculation indicated significant differences in predictive value of SAVE Score for survival among its different indications. (Area Under the Curve= 81.69% for IWOCB, 53.79% for eCPR and 69.46% for RCS). Conclusion: VA ECMO indication markedly affects the predictive value of SAVE Score. Prediction of primary outcome in IWOCB patients was reliable. On the contrary, routine application for survival estimation in eCPR patients is not supported from our results.

Pulmonary Infections

Chest Imaging ◽  
2019 ◽  
pp. 187-189
Author(s):  
Santiago Martínez-Jiménez
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Clinical Response ◽  
Chest Radiography ◽  
Community Acquired Pneumonia ◽  
Clinical Perspective ◽  
Immunosuppressed Patients ◽  
Hospital Acquired Pneumonia ◽  
Healthcare Associated ◽  
Hospital Acquired

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

Pharmacokinetics of linezolid for methicillin-resistant Staphylococcus aureus pneumonia in an adult receiving extracorporeal membrane oxygenation

2020 ◽  
Vol 77 (11) ◽  
pp. 877-881 ◽  
Author(s):  
Peter Nikolos ◽  
Justin Osorio ◽  
Kerry Mohrien ◽  
Christina Rose
Keyword(s):  
Staphylococcus Aureus ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Plasma Concentrations ◽  
Area Under The Curve ◽  
Volume Of Distribution ◽  
Minimum Concentration ◽  
Methicillin Resistant ◽  
Membrane Oxygenation

Abstract Purpose We present a case of a 55-year-old man post right lung transplantation receiving ECMO for treatment of respiratory failure secondary to methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Summary Extracorporeal membrane oxygenation (ECMO) is a frequently utilized support therapy for patients with cardiac and/or respiratory failure. Dosing of medications during ECMO can be challenging due to several factors, including sequestration of medications within ECMO circuits, alterations in volume of distribution, and changes in drug clearance. The patient was initiated on empiric antibiotics, then switched to linezolid at a dose of 600 mg every 8 hours. Linezolid plasma concentrations were collected 30 minutes prior to the sixth administered dose and 30 minutes following the 1-hour infusion of the sixth dose, which resulted in values of 0.4 and 1.7 μg/mL, respectively. The ratio of 24-hour area under the curve (AUC0-24) to minimum inhibitory concentration (MIC), assuming a MIC of 2 μg/mL, was calculated using the extrapolated maximum concentration (1.9 μg/mL) and minimum concentration (0.35 μg/mL), resulting in an AUC0-24/MIC value of 10.8. Due to subtherapeutic linezolid plasma concentrations, ceftaroline was initiated and continued for a total of 18 days. To our knowledge, this is the second report to describe inadequate plasma concentrations of linezolid during ECMO. Conclusion In the case described here, linezolid at a dose of 600 mg every 8 hours did not achieve target plasma concentrations in a patient receiving concomitant venovenous ECMO support.

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