| Arteriovenous extracorporeal lung assist as integral part of a multimodal treatment concept: a retrospective analysis of 22 patients with ARDS refractory to standard care. | |
| | |
MedLine Citation:
|
PMID: 18662425 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND AND OBJECTIVES: Pumpless arteriovenous extracorporeal lung assist is increasingly used as a rescue therapy in acute respiratory distress syndrome. Arteriovenous extracorporeal lung assist is highly efficient in eliminating carbon dioxide and allows the application of ventilator techniques that prioritize lung protection and aim to reduce ventilator-induced lung injury and remote organ dysfunction. METHODS: Retrospective data analysis performed in a 12-bed university hospital ICU. In all, 22 patients with acute respiratory distress syndrome refractory to standard care were included. Arteriovenous extracorporeal lung assist as central part of a multimodal treatment concept was combined with tidal volume (VT) reduction below 4 mL kg-1 predicted body weight, a positive end-expiratory pressure titrated to optimize oxygenation and continuous axial rotation. RESULTS: Hypercapnia was reversed within 24 h in survivors (39 mmHg (35-42) (median and interquartile range) vs. 65 mmHg (54-72), P < 0.05) and non-survivors (5.2 kPa (5.5-6.0) vs. 10 kPa (6.9-13.9), P < 0.05). Oxygenation was significantly improved in survivors after 24 h (PaO2/FiO2 ratio 20.7 kPa (17.4-22.7) vs. 11.7 kPa (7.3-20.8), P < 0.05). All patients required norepinephrine infusion and volume resuscitation. The overall complication rate was 23%, predominantly due to reversible lower limb ischaemia. One patient (5%) was permanently disabled due to amputation of a seriously injured lower leg 9 days after initiation of arteriovenous extracorporeal lung assist therapy; however, the patient survived without neurological deficits despite an initial oxygenation index of 4.4 kPa. The overall mortality rate was 27%. CONCLUSIONS: A multimodal treatment concept with arteriovenous extracorporeal lung assist as its central part provides reversal of hypercapnia and stabilization of oxygenation. In an attempt to maximize lung protection and potentially reduce ventilator-induced lung injury, a further VT reduction below 4 mL kg(-1) predicted body weight combined with a high mean airway pressure and continuous axial rotation is safely possible. |
| | |
Authors:
|
R M Muellenbach; M Kredel; C Wunder; J Küstermann; T Wurmb; U Schwemmer; F Schuster; M Anetseder; N Roewer; J Brederlau |
Related Documents
:
|
1494715 - Effects of cardiac oscillations on acinar gas mixing during pulmonary edema. 3960855 - Cardiopulmonary response to an induced pulse in intracranial pressure. 2361885 - Micropuncture pressure in small arteries or veins of perfused rabbit lungs. 1311515 - Paraquat-induced lung injury: prevention by n-tert-butyl-alpha-phenylnitrone, a free-ra... 7044815 - Intracerebroventricular angiotensin ii increases arterial blood pressure in rhesus monk... 22327685 - Comparing brain tissue oxygen measurements and derived autoregulation parameters from d... |
Publication Detail:
|
Type: Journal Article Date: 2008-07-29 |
Journal Detail:
|
Title: European journal of anaesthesiology Volume: 25 ISSN: 1365-2346 ISO Abbreviation: Eur J Anaesthesiol Publication Date: 2008 Nov |
Date Detail:
|
Created Date: 2008-10-07 Completed Date: 2009-02-03 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8411711 Medline TA: Eur J Anaesthesiol Country: England |
Other Details:
|
Languages: eng Pagination: 897-904 Citation Subset: IM |
Affiliation:
|
University of Wuerzburg, Department of Anaesthesiology, Wuerzburg, Germany. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Body Weight Combined Modality Therapy / methods Extracorporeal Membrane Oxygenation Female Humans Hypercapnia / therapy Lung / metabolism Male Middle Aged Oxygen / metabolism Positive-Pressure Respiration / methods* Respiratory Distress Syndrome, Adult / drug therapy*, therapy* Retrospective Studies Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The conjoint use of music therapy and reflexology with hospitalized advanced stage cancer patients a...
Next Document: Pathways leading to early growth faltering: an investigation into the importance of mucosal damage a...