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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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SUPPORT VENTILATION  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 May;68(5):381-6

language: English

Extracorporeal respiratory support and minimally invasive ventilation in severe ARDS

Frenckner B., Palmér P. *, Lindén V. *

From the Astrid Lindgren Children’s Hospital Karolinska Hospital, Karolinska Institutet Stockholm, Sweden Department of Pediatric Surgery
*Department of ECMO


Back­ground. To eval­u­ate the ­results of treat­ment of ­severe ­acute res­pir­a­to­ry dis­tress syn­drome (­ARDS) ­with extra­cor­po­real ­life sup­port (­ECLS), min­i­mal seda­tion and low pres­sure sup­port­ed ven­ti­la­tion in ­adults.
Meth­ods. ­Design and set­ting: obser­va­tion­al ­study in a ter­tiary refer­ral cen­ter, Inten­sive ­Care ­Unit, ­Astrid Lind­gren ­Children’s Hos­pi­tal at Kar­o­lins­ka Hos­pi­tal, Stock­holm, Swe­den. ­Patients: thir­ty-­eight ­patients ­aged 17-61 ­years (­mean 38) ­with ­severe ­ARDS. The Mur­ray ­score of pul­mo­nary inju­ry aver­aged 3.5 (3.0-4.0) and the ­mean PaO2/FiO2 ­ratio was 47 (31-65). Inter­ven­tion: the ­patients ­were treat­ed ­with ­veno-­venous or ­veno-arte­ri­al ­ECLS ­after fail­ure of con­ven­tion­al res­pir­a­to­ry ther­a­py. A stan­dard ­ECLS cir­cuit ­with no hep­a­ri­nized sur­fac­es was ­used. The ­patients ­were min­i­mal­ly sedat­ed and ­received pres­sure-sup­port­ed ven­ti­la­tion. ­High inspir­a­to­ry pres­sures ­were avoid­ed.
­Results. 25 of the 38 ­patients sur­vived (­total sur­vi­val ­rate 66%) ­after 2-57 ­days on ­ECLS (­mean 17). ­Major sur­gi­cal pro­ce­dures ­were per­formed in sev­er­al ­patients dur­ing ­bypass.
Con­clu­sions. A ­high sur­vi­val ­rate can be ­obtained in ­adult ­patients ­with ­severe ­ARDS ­using ­ECLS, min­i­mal seda­tion and pres­sure-sup­port­ed ven­ti­la­tion ­with low inspir­a­to­ry pres­sures. Sur­gi­cal com­pli­ca­tions are amen­able to sur­gi­cal treat­ment dur­ing ­ECLS and bleed­ing prob­lems can be con­trolled.

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