Document Detail


Combination of extracorporeal membrane oxygenation and high-frequency oscillatory ventilation saved a child with severe ARDS after pulmonary resection.
MedLine Citation:
PMID:  21538204     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
We report a case in which a 2-year-old girl who underwent a right middle and lower lung lobectomy for congenital cystic adenomatoid malformation suffered massive bleeding and developed acute respiratory distress syndrome (ARDS) during the operation. She was ventilated with a high level of F(I)O(2) (0.75-1.0), PEEP (10-20 cmH(2)O), and PIP (33-55 cmH(2)O) to maintain SPO(2) (>90%). Following transfer to the ICU, continuous hemodialysis was introduced to reduce excessive blood volume. However, pulmonary oxygenation did not improve, and marked subcutaneous emphysema occurred on postoperative day 3 (POD 3). We introduced venovenous (V-V) extracorporeal membrane oxygenation (ECMO) to rest the lung, and V-V ECMO was changed to right and left atrial ECMO because of unsatisfactory oxygen support on POD 23. A CT scan showed almost the entire lung had collapsed, even though we had administered diuretics, steroids, nitric oxide, sivelestat, and surfactant for ARDS. We applied high-frequency oscillatory ventilation (HFOV) with a mean airway pressure of 20 cmH(2)O, frequency of 9.2 Hz, and amplitude of 38 cmH(2)O on POD 45. The collapsed lung was then gradually recruited, and pulmonary oxygenation improved (P/F ratio = 434). ECMO was successfully weaned on POD 88. The patient required a tracheostomy, but she was able to function without a ventilator on POD 142. Although HFOV has failed to show a mortality benefit in ARDS patients, the unique lung recruitment by HFOV can be a useful therapeutic option for severe ARDS patients in combination with sufficient lung rest produced by ECMO.
Authors:
Eiji Hashiba; Futoshi Kimura; Yasuyuki Suzuki; Takeshi Asano; Tomoko Ono; Hirobumi Okawa; Toshihito Tsubo; Hironori Ishihara; Kazuyoshi Hirota
Related Documents :
22991384 - The effects of natural orifice translumenal endoscopic surgery (notes) on cardiorespira...
18210364 - Atraumatic suction tip for microneurosurgery--clinical experience.
9917044 - A model to explain the rapid pressure decrease after air-inflation of diseased middle e...
15021764 - Point prevalence of barotitis and its prevention and treatment with nasal balloon infla...
22970534 - Office-based nursing staff management of hypertension in primary care.
18163734 - Adaptation of the bridgman anvil cell to liquid pressure mediums.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-3
Journal Detail:
Title:  Journal of anesthesia     Volume:  -     ISSN:  1438-8359     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan, ehashiba@pc4.so-net.ne.jp.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Head for the hills: The influence of environmental slant on spatial memory organization.
Next Document:  Epidemiologic survey: reference ranges of serum insulin-like growth factor 1 levels in Caucasian adu...