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Matthieu Schmidt, Guillaume Franchineau, Alain Combes
PURPOSE OF REVIEW: To summarize results of the most recent trials on venovenous extracorporeal membrane oxygenation (VV-ECMO) in severe acute respiratory distress syndrome (ARDS) and to elaborate on the unmet needs regarding VV-ECMO management in this setting. RECENT FINDINGS: Although it was terminated early for futility (i.e., failure to demonstrate a difference in 60-day mortality of 20%), the ECMO to Rescue Lung Injury in Severe ARDS trial of VV-ECMO for severe ARDS reported a nonsignificant, but clinically important, reduction in mortality (35 vs...
November 30, 2018: Current Opinion in Critical Care
Gennaro Martucci, Giovanna Panarello, Giovanna Occhipinti, Giuseppe Raffa, Fabio Tuzzolino, Guido Capitanio, Tiziana Carollo, Giovanni Lino, Alessandro Bertani, Patrizio Vitulo, Michele Pilato, Roberto Lorusso, Antonio Arcadipane
Background: Technological improvement has contributed to making veno-venous extracorporeal membrane oxygenation (VV-ECMO) safer and easier, spreading its use in acute respiratory failure (ARF). Methods: This is a retrospective observational study carried out in the ECMO center at IRCCS-ISMETT, a medical center focused on end-stage organ failure treatment in Italy. We investigated the effect of different cannula designs on the amount of blood product transfused. Eighty-nine consecutive patients affected with ARF on VV-ECMO from 2008 to 2016 were compared according to type of cannulation: older percutaneous cannula (Standard group, 52 patients) and HLS© BIOLINE-coated, but with shorter drainage cannula (BIOLINE group, 37 patients)...
October 2018: Journal of Thoracic Disease
Jingyi Shi, Chunxia Wang, Yun Cui, Yucai Zhang
BACKGROUND: Bordetella pertussis can cause fatal illness with severe acute respiratory distress syndrome (ARDS) and pulmonary hypertension (PHT). CASE PRESENTATION: A 6-month-old non-vaccinated boy with B. pertussis infection who developed ARDS was treated by extracorporeal membrane oxygenation (ECMO). During his ECMO support stage, sudden occurred decreasing of ECMO flow implied increasing intrathoracic pressure. The airway spasm followed caused sudden drop of ventilator tidal volume as well as poor lung compliance...
November 30, 2018: BMC Pediatrics
Nicolò Patroniti, Giulia Bonatti, Tarek Senussi, Chiara Robba
Over the past decade, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for respiratory support has widely expanded as a treatment strategy for patients with acute respiratory distress syndrome (ARDS). Despite considerable attention has been given to the indications, the timing and the management of patients undergoing ECMO for refractory respiratory hypoxemic failure, little is known regarding the management of mechanical ventilation (MV) in this group of patients. ECMO enables to minimize ventilatory induced lung injury (VILI) and it has been successfully used as rescue therapy in patients with ARDS when conventional ventilator strategies have failed...
October 2018: Annals of Translational Medicine
R Scott Eldredge, Yan Zhai, Amalia Cochran
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a complication that affects approximately 40% of burn patients and is associated with high mortality rates. Extracorporeal membrane oxygenation (ECMO) therapy is a management option for severe refractory hypoxemic respiratory failure; however, there is little literature reporting the effectiveness of this therapy in burns. Our study objective was to review patient outcomes in burns following severe ARDS treated with ECMO. METHODS: We retrospectively reviewed all patients treated with ECMO for ARDS who received their burn care at a single regional burn center between 9/1/2006 and 8/31/2016...
November 11, 2018: Burns: Journal of the International Society for Burn Injuries
E Tautz, D Wagner, S Wiesemann, A Jonaszik, C Bode, T Wengenmayer, D Staudacher, P Biever, J Hoeppner, D Duerschmied
INTRODUCTION: Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. METHODS AND RESULTS: In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months...
November 11, 2018: Infection
Ewan C Goligher, George Tomlinson, David Hajage, Duminda N Wijeysundera, Eddy Fan, Peter Jüni, Daniel Brodie, Arthur S Slutsky, Alain Combes
Importance: Bayesian analysis of clinical trial data may provide useful information to aid in study interpretation, especially when trial evidence suggests that the benefits of an intervention are uncertain, such as in a trial that evaluated early extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). Objective: To demonstrate the potential utility of Bayesian analyses by estimating the posterior probability, under various assumptions, that early ECMO was associated with reduced mortality in patients with very severe ARDS in a randomized clinical trial (RCT)...
October 22, 2018: JAMA: the Journal of the American Medical Association
N He, Y Y Yan, Y Q Ying, M Yi, G Q Yao, Q G Ge, S D Zhai
Pharmacokinetic parameters can be significantly altered for acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemofiltration therapy (CVVH). Here we reported a case of individualized vancomycin dosing for a patient diagnosed as severe acute pancreatitis treated with concurrent ECMO and CVVH. A 65 kg 32-year-old woman was admitted to hospital presented with severe acute pancreatitis (SAP), respiratory failure, metabotropic acidosis and hyperkalemia. She was admitted to intensive care unit (ICU) on hospital day 1 and was initiated on CVVH...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Andrea Wolfler, Gianfranco Raimondi, Cecilia Pagan de Paganis, Elena Zoia
INTRODUCTION: Bronchiolitis is one of the most frequent reasons for PICU admission in children less than 1 year of age. It causes a wide spectrum of clinical scenarios from mild to severe respiratory failure and supportive therapy range from HFNC to nonconventional ventilation and ECMO in the most severe forms. Aim of this article is to review the available ventilation mode in children with bronchiolitis and the scientific evidence. EVIDENCE ACQUISITION: The main medical databases were explored to search for clinical trials that address management strategies for respiratory support of infants with RSV infection...
October 18, 2018: Minerva Pediatrica
Nisha Krishnakant Raiker, Hector Cajigas
A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2 ) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made...
October 12, 2018: BMJ Case Reports
Paul S Jansson, David C Leisten, Todd M Sarkisian, Susan R Wilcox, Jarone Lee
BACKGROUND: Hydrochlorothiazide (HCTZ) is a commonly prescribed sulfonamide thiazide-type diuretic medication that has been associated with rare cases of noncardiogenic pulmonary edema. CASE REPORT: A man in his 50s with a medical history notable for hypertension was transferred to our institution for evaluation of refractory hypoxemia. After taking an initial dose of HCTZ earlier in the day, he developed progressive respiratory failure and was intubated at a referring hospital...
October 9, 2018: Journal of Emergency Medicine
Joaquin Araos, Leyla Alegria, Patricio Garcia, Pablo Cruces, Dagoberto Soto, Benjamín Erranz, Macarena Amthauer, Tatiana Salomon, Tania Medina, Felipe Rodriguez, Pedro Ayala, Gisella R Borzone, Manuel Meneses, Felipe Damiani, Jaime Retamal, Rodrigo Cornejo, Guillermo Bugedo, Alejandro Bruhn
RATIONALE: There is wide variability in mechanical ventilation settings during ECMO in ARDS patients. Although lung rest is recommended to prevent further injury, there is no evidence to support it. OBJECTIVES: To determine whether near-apneic ventilation decreases lung injury in a pig model of ARDS supported with ECMO. METHODS: Pigs (26-36kg; n=24) were anesthetized and connected to mechanical ventilation. In 18 animals lung injury was induced by a double-hit consisting in repeated saline lavages followed by 2 hours of injurious ventilation...
September 14, 2018: American Journal of Respiratory and Critical Care Medicine
Gang-Feng Yan, Guo-Ping Lu, Zhu-Jin Lu, Wei-Ming Chen
The children with acute respiratory distress syndrome (ARDS) usually require ventilatory support treatment. At present, lung protective ventilation strategy is recommended for the treatment of ARDS. Extracorporeal membrane oxygenation (ECMO) can improve oxygenation and remove carbon dioxide by extracorporeal circuit, and can partially or completely take over cardiopulmonary function. ECMO support showed many advantages in treating severe ARDS, such as reducing ventilator-induced lung injury and correcting hypoxemia...
September 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Madhavi Parekh, Darryl Abrams, Daniel Brodie, Natalie H Yip
The use of extracorporeal membrane oxygenation in the management of ARDS has grown considerably in the past decade, largely as a consequence of improvements in extracorporeal technology and management techniques. Recently published data has helped clarify the use of ECMO in ARDS, and its role in optimizing lung-protective ventilation and minimizing ventilator-induced lung injury has the potential to have a substantial impact on ARDS management and outcomes. In the future, novel extracorporeal management strategies may lead to a new paradigm in our approach to patients with ARDS...
September 2018: Respiratory Care
Jan Florian Heuer, Moritz Mirschel, Annalen Bleckmann, Michael Quintel, Onnen Moerer
Veno-venous extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy for patients with severe acute respiratory distress syndrome (ARDS). ECMO is a technically complex and challenging procedure and should therefore only be performed in specialized centers. Transporting ARDS patients to ECMO centers for treatment can be dangerous because of the risk of hypoxemia during transport. This raises the question if ECMO should not be already initiated in the transferring hospital before transport. Over a 5-year period, we studied ARDS patients who had been transported to our department by our mobile ECMO team for further treatment after ECMO had already been initiated at the referring hospital...
August 18, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Q Maloir, K Ghysen, C von Frenckell, R Louis, J Guiot
Antisynthetase syndrome is a clinical entity characterized by specific anti-aminoacyl-tRNA-synthetase antibodies usually associated with inflammatory myopathy and interstitial lung disease. The classic presentation of the pathology is the pulmonary interstitium involvment, wich commonly determines the global prognosis. The subsequent diagnosis of antisynthetase syndrome in patients with acute respiratory distress syndrome (ARDS) is unusual, even more so when a veino-veinous (VV) extracorporeal membrane oxygenation (ECMO) is required...
July 2018: Revue Médicale de Liège
Sujith V Cherian, Anupam Kumar, Karunakar Akasapu, Rendell W Ashton, Malaygiri Aparnath, Atul Malhotra
Acute Respiratory Distress Syndrome (ARDS) is a condition of varied etiology characterized by the acute onset (within 1 week of the inciting event) of hypoxemia, reduced lung compliance, diffuse lung inflammation and bilateral opacities on chest imaging attributable to noncardiogenic (increased permeability) pulmonary edema. Although multi-organ failure is the most common cause of death in ARDS, an estimated 10-15% of the deaths in ARDS are caused due to refractory hypoxemia, i.e.- hypoxemia despite lung protective conventional ventilator modes...
August 2018: Respiratory Medicine
Thomas Datzmann, Karl Träger
No abstract text is available yet for this article.
June 2018: Journal of Thoracic Disease
W Q Yu, M D Ding, G H Dai, C J Gu, L Xue, Y Chen, D M Zhou, J C Xian, H T Xu
Objective: To describe the clinical, chest imaging, pathological manifestations and therapeutic experience of human infection with A/H7N9 virus. Methods: The features of 15 laboratory-confirmed cases of human infection with A/H7N9 virus in Taizhou, Jiangsu Province were retrospectively analyzed. Results: The 15 patients with confirmed viral pneumonia included 12 males and 3 females, with a median age of 61 years(ranging from 33 to 81 years). Twelve patients had a history of exposure to the poultry trading places, or direct contact with ill/dead avian, while 3 patients denied exposure or contact...
July 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
Gautam Rawal, Sankalp Yadav, Raj Kumar
Acute respiratory distress syndrome (ARDS) is a life threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure and was first recognized in 1960s.Since its first description, it has undergone intensive research in the past few decades to understand its pathogenesis and therapies. Despite this, the recommended therapies to decrease mortality in ARDS remain limited and include low-tidal volume mechanical ventilation, prone ventilation and recently, the ECMO rescue therapy in extreme cases...
June 2018: Journal of Translational Internal Medicine
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