scholarly journals Mechanical Power during Veno-Venous Extracorporeal Membrane Oxygenation Initiation: A Pilot-Study

Membranes ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 30
Author(s):  
Mirko Belliato ◽  
Francesco Epis ◽  
Luca Cremascoli ◽  
Fiorenza Ferrari ◽  
Maria Giovanna Quattrone ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Ideal Body Weight ◽  
Plateau Pressure ◽  
Mechanical Power ◽  
Membrane Oxygenation ◽  
Icu Outcome ◽  
Ideal Body ◽  
Early Phases ◽  
Vv Ecmo

Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH2O, p = 0.012), driving pressure (11 vs. 8 cmH2O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (VT/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH2O, p = 0.048) and VT/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.

Opioid and Benzodiazepine Requirements in Obese Adult Patients Receiving Extracorporeal Membrane Oxygenation

2019 ◽  
Vol 54 (2) ◽  
pp. 144-150
Author(s):  
Brittany S. Verkerk ◽  
Amy L. Dzierba ◽  
Justin Muir ◽  
Caroline Der-Nigoghossian ◽  
Daniel Brodie ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Adult Patients ◽  
Obese Group ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Membrane Oxygenation ◽  
Baseline Characteristics ◽  
The Impact ◽  
Vv Ecmo

Background: The use of extracorporeal membrane oxygenation (ECMO) sometimes requires deep levels of sedation (Richmond Agitation Sedation Scale [RASS] −5) in patients with acute respiratory distress syndrome (ARDS). The role of obesity in opioid and sedative requirements remains unclear in patients receiving ECMO. Objective: This study sought to determine whether obesity increases midazolam and opioid requirements in patients receiving venovenous (vv)-ECMO up to the first 7 days after initiation. Methods: This was a retrospective cohort study of adult patients with ARDS managed with vv-ECMO. Results: The obese (n = 38) and nonobese (n = 43) groups had similar baseline characteristics. Fentanyl equivalents were significantly higher on day 3 in the obese group ( P = 0.02) despite similar RASS scores with no differences in midazolam requirements. There were no differences in duration of ECMO, length of stay, or mortality. Conclusion and Relevance: Daily midazolam requirements were not significantly different, and opioid requirements were only significantly higher in the obese group on day 3 despite similar levels of sedation. The impact of obesity with the addition of ECMO and how to adapt doses of medications remains elusive.

Role of circulating adipocytokines vaspin, apelin, and visfatin in the loss of appetite in underweight children: a pilot trial

2015 ◽  
Vol 28 (9-10) ◽  
Author(s):  
Aysel Vehapoglu ◽  
Feyza Ustabas ◽  
Tolga I. Ozgen ◽  
Sule Terzioglu ◽  
Banu B. Cermik ◽  
...  
Keyword(s):  
Pilot Trial ◽  
Ideal Body Weight ◽  
Serum Concentrations ◽  
Immunoassay Technique ◽  
Body Weights ◽  
Ideal Body ◽  
And Gender ◽  
Loss Of Appetite ◽  
Enzyme Immunoassay Technique

AbstractTo investigate serum concentrations of vaspin, apelin, and visfatin in underweight children and their association with anthropometric and nutritional markers of malnutrition.We recruited 44 underweight prepubertal children (youngest age=2 years) with thinness grades of 1, 2, and 3, and body weights <90% of ideal body weight due to loss of appetite and less frequent hunger episodes. Forty-one healthy age- and gender-matched controls were also included in the study. Serum fasting vaspin, apelin, and visfatin concentrations were measured by enzyme immunoassay technique.Mean vaspin and apelin levels were significantly lower in underweight children compared to controls (vaspin: 0.44±0.18 vs. 0.58±0.35 pg/mL, p=0.024; apelin: 483.37±333.26 vs. 711.71±616.50 pg/mL, p=0.041). Visfatin levels were lower in underweight children compared to controls, but the values were not statistically significant (177.81±158.01 vs. 221.15±212.94 pg/mL, p=0.119).: In underweight children, decreased vaspin and apelin levels should be considered in the etiology of anorexia.

scholarly journals Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Arie Soroksky ◽  
Julia Kheifets ◽  
Zehava Girsh Solomonovich ◽  
Emad Tayem ◽  
Balmor Gingy Ronen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Ideal Body Weight ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Successful Management ◽  
Esophageal Balloon ◽  
Ideal Body

Purpose. Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia.Materials and Methods. Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures. Positive end expiratory pressure (PEEP) and inspiratory driving pressures were adjusted with the aim of achieving tidal volume of 6 to 8 mL/kg based on ideal body weight (IBW), while not exceeding end inspiratory transpulmonary (EITP) pressure of 25 cm H2O.Results. Six patients with severe ARDS and hypercapnia were studied. Mean PaCO2on enrollment was108.33±25.65 mmHg. One hour after adjustment of PEEP and inspiratory driving pressure guided by transpulmonary pressure, PaCO2decreased to64.5±16.89 mmHg (P<0.01). Tidal volume was3.96±0.92 mL/kg IBW before and increased to7.07±1.21 mL/kg IBW after intervention(P<0.01). EITP pressure before intervention was low with a mean of13.68±8.69 cm H2O and remained low at16.76±4.76 cm H2O (P=0.18) after intervention. Adjustment of PEEP and inspiratory driving pressures did not worsen oxygenation and did not affect cardiac output significantly.Conclusion. The use of esophageal balloon as a guide to mechanical ventilation was able to treat severe hypercapnia in ARDS patients.

scholarly journals Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Benoit Vandenbunder ◽  
◽  
Stephan Ehrmann ◽  
Michael Piagnerelli ◽  
Bertrand Sauneuf ◽  
...  
Keyword(s):  
Linear Regression ◽  
Respiratory System ◽  
Ideal Body Weight ◽  
Plateau Pressure ◽  
Chronic Hypertension ◽  
Static Compliance ◽  
Multicenter Cohort ◽  
Controlled Mechanical Ventilation ◽  
Ideal Body ◽  
International Multicenter Study

Abstract Background Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. Methods In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. Results The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98–1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13–3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88–0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome. Conclusion In a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.

Participation of Maternal and Fetal CRH in Early Phases of Human Implantation: The Role of Antalarmin

2004 ◽  
Vol 4 (1) ◽  
pp. 75-78 ◽  
Author(s):  
A. Makrigiannakis ◽  
E. Zoumakis ◽  
S. Kalantaridou ◽  
G. Chrousos ◽  
A. Gravanis
Keyword(s):  
Early Phases ◽  
Human Implantation

Determining Ideal Body Weight (and Mass)

1983 ◽  
Vol 40 (10) ◽  
pp. 1622-1627 ◽  
Author(s):  
Alan W. Hopefl ◽  
Donald R. Miller ◽  
James D. Carlson ◽  
Beverly J. Lloyd ◽  
Brian Jack Day ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Ideal Body

scholarly journals ECMO in COVID-19—prolonged therapy needed? A retrospective analysis of outcome and prognostic factors

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Esther Dreier ◽  
Maximilian Valentin Malfertheiner ◽  
Thomas Dienemann ◽  
Christoph Fisser ◽  
Maik Foltan ◽  
...  
Keyword(s):  
Lung Compliance ◽  
Ecmo Support ◽  
Short Term ◽  
Single Center Study ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Baseline Characteristics ◽  
Ecmo Therapy ◽  
Vv Ecmo

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.

scholarly journals Dosing of neuromuscular blocking agents in patients with obesity: A narrative review

2021 ◽  
pp. 0310057X2096857
Author(s):  
Brian L Erstad ◽  
Jeffrey F Barletta
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Patient Specific ◽  
Lean Body Weight ◽  
Short Term ◽  
Blocking Agents ◽  
Ideal Body ◽  
Size Descriptor

There is no consensus on which weight clinicians should use for weight-based dosing of neuromuscular blocking agents (NMBAs), as exemplified by differing or absent recommendations in clinical practice guidelines. The purpose of this paper is to review studies that evaluated various size descriptors for weight-based dosing of succinylcholine and non-depolarising NMBAs, and to provide recommendations for the descriptors of choice for the weight-based dosing of these agents in patients with obesity. All of the studies conducted to date involving depolarising and non-depolarising NMBAs in patients with obesity have assessed single doses or short-term infusions conducted in perioperative settings. Recognising that any final dosing regimen must take into account patient-specific considerations, the available evidence suggests that actual body weight is the size descriptor of choice for weight-based dosing of succinylcholine and that ideal body weight, or an adjusted (or lean) body weight, is the size descriptor of choice for weight-based dosing of non-depolarising NMBAs.

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