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Simonte R, Cammarota G, Vetrugno L, De Robertis E, Longhini F, Spadaro S. Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation. J Clin Med 2024; 13:2541. [PMID: 38731069 PMCID: PMC11084162 DOI: 10.3390/jcm13092541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Advanced respiratory monitoring encompasses a diverse range of mini- or noninvasive tools used to evaluate various aspects of respiratory function in patients experiencing acute respiratory failure, including those requiring extracorporeal membrane oxygenation (ECMO) support. Among these techniques, key modalities include esophageal pressure measurement (including derived pressures), lung and respiratory muscle ultrasounds, electrical impedance tomography, the monitoring of diaphragm electrical activity, and assessment of flow index. These tools play a critical role in assessing essential parameters such as lung recruitment and overdistention, lung aeration and morphology, ventilation/perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient-ventilator synchrony. In contrast to conventional methods, advanced respiratory monitoring offers a deeper understanding of pathological changes in lung aeration caused by underlying diseases. Moreover, it allows for meticulous tracking of responses to therapeutic interventions, aiding in the development of personalized respiratory support strategies aimed at preserving lung function and respiratory muscle integrity. The integration of advanced respiratory monitoring represents a significant advancement in the clinical management of acute respiratory failure. It serves as a cornerstone in scenarios where treatment strategies rely on tailored approaches, empowering clinicians to make informed decisions about intervention selection and adjustment. By enabling real-time assessment and modification of respiratory support, advanced monitoring not only optimizes care for patients with acute respiratory distress syndrome but also contributes to improved outcomes and enhanced patient safety.
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Affiliation(s)
- Rachele Simonte
- Department of Medicine and Surgery, Università degli Studi di Perugia, 06100 Perugia, Italy; (R.S.); (E.D.R.)
| | - Gianmaria Cammarota
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Università degli Studi di Perugia, 06100 Perugia, Italy; (R.S.); (E.D.R.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Università della Magna Graecia, 88100 Catanzaro, Italy
- Anesthesia and Intensive Care Unit, “R. Dulbecco” University Hospital, 88100 Catanzaro, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44100 Ferrara, Italy;
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Guo L, Zeng J, Liu Z, Wei Z, Wen C, Zhang Y, Chen X, Xie H. Observation of Curative Effect of Lung Recruitment in Patients with Acute Respiratory Distress Syndrome after Cardiopulmonary Bypass Surgery. Appl Bionics Biomech 2022; 2022:2693500. [PMID: 36133746 PMCID: PMC9484963 DOI: 10.1155/2022/2693500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Recruitment maneuver (RM) has become a routine supplementary maneuver for clinical rescue of severe ARDS with low tidal volume/pressure-limited mechanical ventilation. Recruitment of patients with ARDS mechanical ventilation can improve the lung compliance, promote the opening of collapsed alveoli, improve the ratio of ventilation to blood flow, reduce dead space, reduce shunt flow, and improve oxygenation function. In this paper, the patients were divided into lung recruitment group and conventional treatment group by the random number permutation table method. When the patient's percutaneous oxygen saturation is less than or equal to 88%, the partial pressure of oxygen in the arterial blood gas is less than or equal to 55 mmHg, or the ventilator tube is disconnected during sputum suction or other accidents, a CPAP × 60 - second lung recruitment maneuver is required. Then adjust the ventilator parameters in the same way. In the process of lung recruitment, the changes in invasive continuous arterial blood pressure will also be observed. If the blood pressure dropped to ≤90/60 mmHg, one recruitment maneuver was terminated in advance. And both groups of patients used the Dräger- or PB840-imported multifunctional ventilator. The treatment of primary disease and predisposing factors, fluid management strategies, antibiotics and glucocorticoids, nutrition, and metabolic support in the two groups of patients in the study were the same. The PaO2/FiO2 value improved by 51% 10 minutes after recruitment, and the median increased from 111 (IQR, 73-265) before recruitment to 170 (IQR, 102-340) (P < 0.01), the improvement of PaO2/FiO2 at 4 hours after recruitment and 12 hours after recruitment was 78% (P < 0.05) and 39% (P < 0.01), respectively, and the median PaO2/FiO2 at 4 hours after recruitment was 198 (IQR, 116-256). The median PaO2/FiO2 became 155 (IQR, 127-235) 12 hours after recruitment. Recruitment can reduce the accumulation of neutrophils in lung tissue, reduce the release of inflammatory factors, reduce pulmonary edema, and reduce pathological damage.
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Affiliation(s)
- Lin Guo
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Jinxiu Zeng
- Disinfection Supply Centers, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Ziyou Liu
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Zijie Wei
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Caiyun Wen
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Yue Zhang
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Xu Chen
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
| | - Heping Xie
- Cardiac ICU, First Affiliated Hospital of Gannan Medical College, Ganzhou, 341000 Jiangxi, China
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