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Bronchoscopy AND ECMO

Stijn E Verleden, An Martens, Sofie Ordies, Arne P Neyrinck, Dirk E Van Raemdonck, Geert M Verleden, Bart M Vanaudenaerde, Robin Vos
INTRODUCTION: Previous studies demonstrated that increased cytokine and chemokine levels, either shortly before or after lung transplantation, were associated with post-transplant outcome. However, small patient cohorts were mostly used, focusing on 1 molecule and 1 outcome. In a large single-center cohort, we investigated the predictive value of immediate post-operative broncho-alveolar lavage (BAL) expression of IL-6 and IL-8 on multiple key outcomes, including PGD, CLAD, graft survival, as well as several secondary outcomes...
April 2018: Clinical Transplantation
Gerard Cortina, Christian Niederwanger, Uwe Klingkowski, Corinna Velik-Salchner, Nikolaus Neu
Most children with severe respiratory failure require extracorporeal membrane oxygenation (ECMO) for 7-10 days. However, some may need prolonged duration ECMO (> 14 days). To date, no consensus exists on how long to wait for native lung recovery. Here we report the case of a 3-year-old boy who developed severe necrotizing pneumonia requiring venovenous (VV) ECMO after 19 days of mechanical ventilation. In the first 4 weeks of his ECMO run, he showed no lung aeration, requiring total extracorporeal support...
February 5, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
J-H Zhu, M Lei, E-G Chen, Q Qiao, T-D Zhong
BACKGROUND: Stenting of airway stenosis is a common procedure in specialized centers. The aim of this study was to summarize our clinical experience in ventilation strategy and anesthesia management of patients undergoing urgent tracheal stenting. METHODS: Clinical data of 22 patients with severe tracheal stenosis who underwent urgent endoscopic placement of a tracheal stent during a 2-year period were retrospectively reviewed. The efficacy and safety of different ventilation strategies and veno-arterial extracorporeal membrane oxygenation (ECMO), individualized based on the cause and location of tracheal narrowing, were evaluated...
May 2018: Acta Anaesthesiologica Scandinavica
Filippo Antonacci, Chiara De Tisi, Ilaria Donadoni, Marco Maurelli, Giorgio Iotti, Fabio Silvio Taccone, Giulio Orlandoni, Carlo Pellegrini, Mirko Belliato
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used extensively in cardiothoracic surgery both for hemodynamic and respiratory support. It has proven to be a valuable tool to maintain adequate oxygenation during tracheal surgery. Airway lesion may be an indication for veno-venous ECMO both in case of conservative management and in case of surgical repair. Here we report the case of a patient with a iatrogenic tracheal injury, successfully operated with the support of veno-venous extracorporeal oxygenation...
2018: International Journal of Surgery Case Reports
Stefan Guth, Christoph B Wiedenroth, Marc Wollenschläger, Manuel Jonas Richter, Hossein A Ghofrani, Matthias Arlt, Eckhard Mayer
OBJECTIVES: Pulmonary endarterectomy (PEA) is the only curative treatment option for patients with chronic thromboembolic pulmonary hypertension. Massive endobronchial bleeding that precludes weaning from cardiopulmonary bypass is an often-fatal complication of PEA. The aim of this study was to determine whether short-term extracorporeal membrane oxygenation (ECMO) is a safe and feasible procedure in patients with severe endobronchial bleeding. METHODS: From January 2014 to December 2016, 396 patients (mean age 60 ± 18 years, 54...
February 2018: Journal of Thoracic and Cardiovascular Surgery
Vaclav Vobruba, Tomas Grus, Frantisek Mlejnsky, Jan Belohlavek, Jan Hridel, Lukas Lambert
Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped...
August 1, 2017: Perfusion
W Jonathan Dunkman, Alina Nicoara, Jacob Schroder, Momen M Wahidi, Aimen El Manafi, Desiree Bonadonna, Coral X Giovacchini, Frederick W Lombard
We present a case in which we electively used venovenous extracorporeal membrane oxygenation (VV-ECMO) to facilitate safe resection of a nearly obstructing airway tumor near the carina in a 37-year-old male. The patient was brought to the operating room and underwent bifemoral cannulation for VV-ECMO under light sedation while maintaining spontaneous ventilation. After VV-ECMO was initiated, general anesthesia was induced, and the tumor was resected via rigid bronchoscopy. After resection, the patient was intubated, weaned from ECMO, decannulated, awoken, extubated, and taken to the postanesthesia care unit for recovery...
August 15, 2017: A & A Case Reports
Christopher L Jenks, Jefferson Tweed, Kristin H Gigli, Ramgopal Venkataraman, Lakshmi Raman
Although the optimal ventilation strategy is unknown for patients placed on extracorporeal support, there are increasing reports of extubation being used. Our objective was to describe the change in ventilation strategies and use of tracheostomy and bronchoscopy practices among extracorporeal membrane oxygenation (ECMO) centers across the world. A descriptive, cross-sectional 22 item survey of neonatal, pediatric, and adult ECMO centers was used to evaluate ventilator strategies, extubation, bronchoscopy, and tracheostomy practices...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Nao Umei, Shingo Ichiba
The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m2 ) successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. The patient was weaned from ECMO on day 5, extubated on day 16, and discharged on day 21...
2017: Case Reports in Critical Care
Christian Biancosino, Marcus Krüger, Christian Kühn, Norman Zinne, Michaela Wilhelmi, Christian Zeckey, Christian Krettek, Martin Gathen
Complex tracheobronchial injuries, especially if both main bronchi are involved, are life threatening and their diagnosis and successful treatment concerning short-term as well as long-term results are most challenging. This is the first report on a successful reconstruction of a complex bilateral bronchial injury under extracorporeal membrane oxygenation (ECMO) support. We present the course from prehospital treatment, establishment of ECMO in the emergency room to initial bronchoscopy, operative reconstruction, and intensive care therapy...
August 2016: Annals of Thoracic Surgery
Silvia Chacón-Alves, Jose Luis Pérez-Vela, Teodoro Grau-Carmona, Helena Domínguez-Aguado, Helena Marín-Mateos, Emilio Renes-Carreño
Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We present a patient with airway obstruction and acute respiratory failure due to large blood clots obstructing the trachea and main left bronchus. This condition was accompanied by right ventricle failure and cardiogenic shock. A venoarterial ECMO system was used for cardiopulmonary support before extracting the clots and clearing the airway by rigid bronchoscopy...
July 4, 2016: International Journal of Artificial Organs
Harrison T Pitcher, Meredith A Harrison, Colette Shaw, Scott W Cowan, Hitoshi Hirose, Nicholas Cavarocchi
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously. METHODS: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis...
May 25, 2016: Perfusion
Q Ballouhey, R Fesseau, V Benouaich, S Lagarde, S Breinig, B Léobon, P Galinier
INTRODUCTION: Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients. METHODS: We reviewed a series of 27 patients with post-traumatic TBR treated since 1996 in our pediatric trauma center. RESULTS: Seven cases had persistent and large volume air leaks...
April 2013: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Nirmal S Sharma, Timothy Peters, Tejaswini Kulkarni, Charles W Hoopes, Scott C Bellot, Keith M Wille, Enrique Diaz-Guzman
BACKGROUND: Previous studies have demonstrated the safety of flexible bronchoscopy (FB) in mechanically ventilated subjects. However, the safety of FB in adult subjects receiving extracorporeal membrane oxygenation (ECMO) has not been described previously. METHODS: A retrospective review was conducted of all adult subjects who underwent FB while receiving ECMO support at the University of Alabama at Birmingham Hospital from January 1, 2013, to December 31, 2014...
May 2016: Respiratory Care
Nirmal S Sharma, Keith M Wille, S Christopher Bellot, Enrique Diaz-Guzman
Extracorporeal membrane oxygenation (ECMO) has been used to provide "lung rest" through the use of low tidal volume (6 ml/kg) and ultralow tidal volume (<6 ml/kg) ventilation in acute respiratory distress syndrome (ARDS). Low and ultralow tidal volume ventilation can result in low dynamic respiratory compliance and potentially increased retention of airway secretions. We present our experience using automated rotational percussion beds (ARPBs) and bronchoscopy in four ARDS patients to manage increased pulmonary secretions...
May 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Tanmay S Panchabhai, Joseph E Khabbaza, Siva Raja, Atul C Mehta, Umur Hatipoğlu
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia is associated with very high mortality. Though surgical evacuation of necrotic tissue is desirable in patients unresponsive to antimicrobial therapy, most patients are acutely ill precluding surgical intervention. We utilized a combination of extracorporeal membrane oxygenation (ECMO) with frequent toilet bronchoscopies to salvage an unaffected right lung from spillage of necrotic pus from left lung cavitary CA-MRSA pneumonia in a 22-year-old patient...
October 2015: Annals of Thoracic Medicine
Philipp Jungebluth, Bernhard Holzgraefe, Mei Ling Lim, Adil Doganay Duru, Vanessa Lundin, Nina Heldring, Oscar P B Wiklander, Joel Z Nordin, Michael Chrobok, Christoph Roderburg, Sebastian Sjöqvist, Björn Anderstam, Antonio Beltrán Rodríguez, Johannes C Haag, Ylva Gustafsson, Katharina G Roddewig, Petra Jones, Matthew J A Wood, Tom Luedde, Ana I Teixeira, Ola Hermanson, Ola Winqvist, Håkan Kalzén, Samir El Andaloussi, Evren Alici, Paolo Macchiarini
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a devastating disorder. Despite enormous efforts in clinical research, effective treatment options are lacking, and mortality rates remain unacceptably high. OBJECTIVES: A male patient with severe ARDS showed no clinical improvement with conventional therapies. Hence, an emergent experimental intervention was performed. METHODS: We performed intratracheal administration of autologous peripheral blood-derived mononuclear cells (PBMCs) and erythropoietin (EPO)...
2015: Respiration; International Review of Thoracic Diseases
Aidan M Hodges, Michael J Gillham, Christopher A Lewis
A bronchopleural fistula (BPF) is a life-threatening complication of cardiothoracic surgery and acute illness. There is no consensus on how best to treat a BPF. Recently, endobronchial one-way valves, designed for bronchoscopic lung volume reduction in emphysema, have been used to treat BPFs. We describe the use of an endobronchial oneway valve, placed at the bedside via flexible bronchoscopy, to treat a BPF in a patient with hypoxic respiratory failure, supported by extracorporeal membrane oxygenation (ECMO), secondary to pneumonia...
September 2015: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Tin Jasinovic, Frederick K Kozak, J Paul Moxham, Mark Chilvers, David Wensley, Michael Seear, Andrew Campbell, Jeffrey P Ludemann
OBJECTIVES: To review clinical presentations and management strategies for children with plastic bronchitis. METHODS: Retrospective chart review. RESULTS: Seven patients required rigid bronchoscopy to remove bronchial casts over a 17-year study period. Mean age at presentation was 60 months. Mean follow-up was 53 months. Co-morbidities included: congenital heart disease (n=3), chronic pulmonary disorders (n=2) and sickle cell disease (n=1)...
October 2015: International Journal of Pediatric Otorhinolaryngology
Narjust Duma, Christian Barlow, Larysa Sanchez, Sean Sadikot
A 61-year-old Caucasian man with hypertension and hepatitis C presented to the emergency department with 7 days of productive cough and low-grade fevers despite outpatient therapy with oral azithromycin. On initial evaluation, he was lethargic with peripheral cyanosis and oxygen saturation in the low 70 s on room air, necessitating endotracheal intubation. Chest imaging revealed diffuse bilateral infiltrates compatible with the diagnosis of acute respiratory distress syndrome. Patient subsequently developed profound hypoxaemia and on day 2 of admission, veno-veno extracorporeal membrane oxygenation (ECMO) was initiated...
June 10, 2015: BMJ Case Reports
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