| Combination of extracorporeal membrane oxygenation and high-frequency oscillatory ventilation saved a child with severe ARDS after pulmonary resection. | |
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MedLine Citation:
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PMID: 21538204 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Eiji Hashiba; Futoshi Kimura; Yasuyuki Suzuki; Takeshi Asano; Tomoko Ono; Hirobumi Okawa; Toshihito Tsubo; Hironori Ishihara; Kazuyoshi Hirota |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-3 |
Journal Detail:
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Title: Journal of anesthesia Volume: - ISSN: 1438-8359 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-3 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8905667 Medline TA: J Anesth Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan, ehashiba@pc4.so-net.ne.jp. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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