SUPPORT VENTILATION  SMART 2002 Milan, May 29-31, 2002 Free access

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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.