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Douflé G, Dragoi L, Morales Castro D, Sato K, Donker DW, Aissaoui N, Fan E, Schaubroeck H, Price S, Fraser JF, Combes A. Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation. Intensive Care Med 2024; 50:632-645. [PMID: 38598123 DOI: 10.1007/s00134-024-07333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/20/2024] [Indexed: 04/11/2024]
Abstract
Bedside ultrasound represents a well-suited diagnostic and monitoring tool for patients on extracorporeal membrane oxygenation (ECMO) who may be too unstable for transport to other hospital areas for diagnostic tests. The role of ultrasound, however, starts even before ECMO initiation. Every patient considered for ECMO should have a thorough ultrasonographic assessment of cardiac and valvular function, as well as vascular anatomy without delaying ECMO cannulation. The role of pre-ECMO ultrasound is to confirm the indication for ECMO, identify clinical situations for which ECMO is not indicated, rule out contraindications, and inform the choice of ECMO configuration. During ECMO cannulation, the use of vascular and cardiac ultrasound reduces the risk of complications and ensures adequate cannula positioning. Ultrasound remains key for monitoring during ECMO support and troubleshooting ECMO complications. For instance, ultrasound is helpful in the assessment of drainage insufficiency, hemodynamic instability, biventricular function, persistent hypoxemia, and recirculation on venovenous (VV) ECMO. Lung ultrasound can be used to monitor signs of recovery on VV ECMO. Brain ultrasound provides valuable diagnostic and prognostic information on ECMO. Echocardiography is essential in the assessment of readiness for liberation from venoarterial (VA) ECMO. Lastly, post decannulation ultrasound mainly aims at identifying post decannulation thrombosis and vascular complications. This review will cover the role of head-to-toe ultrasound for the management of adult ECMO patients from decision to initiate ECMO to the post decannulation phase.
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Affiliation(s)
- Ghislaine Douflé
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Diana Morales Castro
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Nadia Aissaoui
- Service de Médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Hannah Schaubroeck
- Department of Intensive Care Medicine, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
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Cha S, Kostibas MP. Echocardiographic and Point-of-Care Ultrasonography (POCUS) Guidance in the Management of the ECMO Patient. J Clin Med 2024; 13:2630. [PMID: 38731160 PMCID: PMC11084171 DOI: 10.3390/jcm13092630] [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: 03/15/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
Veno-arterial (V-A) and Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support is increasingly utilized for acute cardiogenic shock and/or respiratory failure. Echocardiography and point-of-care ultrasonography (POCUS) play a critical role in the selection and management of these critically ill patients, however, there are limited guidelines regarding their application. This comprehensive review describes current and potential application of echocardiography and POCUS for pre-ECMO assessment and patient selection, cannulation guidance with emphasis on dual-lumen configurations, diagnosis of ECMO complications and trouble-shooting of cannula malposition, diagnosis of common cardiac or pulmonary pathologies, and assessment of ECMO weaning appropriateness including identification of the aortic mixing point in V-A ECMO.
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Affiliation(s)
- Stephanie Cha
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street Suite 6216, Baltimore, MD 21287, USA;
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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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Bianzina S, Singh Y, Iacobelli R, Amodeo A, Guner Y, Di Nardo M. Use of point-of-care ultrasound (POCUS) to monitor neonatal and pediatric extracorporeal life support. Eur J Pediatr 2024; 183:1509-1524. [PMID: 38236403 DOI: 10.1007/s00431-023-05386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive life support technique that requires a blood pump, an artificial membrane lung, and vascular cannulae to drain de-oxygenated blood, remove carbon dioxide, oxygenate, and return it to the patient. ECMO is generally used to provide advanced and prolonged cardiopulmonary support in patients with refractory acute cardiac and/or respiratory failure. After its first use in 1975 to manage a severe form of meconium aspiration syndrome with resultant pulmonary hypertension, the following years were dominated by the use of ECMO to manage neonatal respiratory failure and limited to a few centers across the world. In the 1990s, evidence for neonatal respiratory ECMO support increased; however, the number of cases began to decline with the use of newer pharmacologic therapies (e.g., inhaled nitric oxide, exogenous surfactant, and high-frequency oscillatory ventilation). On the contrary, pediatric ECMO sustained steady growth. Combined advances in ECMO technology and bedside medical management have improved general outcomes, although ECMO-related complications remain challenging. Point-of-care ultrasound (POCUS) is an essential tool to monitor all phases of neonatal and pediatric ECMO: evaluation of ECMO candidacy, ultrasound-guided ECMO cannulation, daily evaluation of heart and lung function and brain perfusion, detection and management of major complications, and weaning from ECMO support. Conclusion: Based on these considerations and on the lack of specific guidelines for the use of POCUS in the neonatal and pediatric ECMO setting, the aim of this paper is to provide a systematic overview for the application of POCUS during ECMO support in these populations. What is Known: • Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary support for patients with refractory acute cardiac and/or respiratory failure and requires appropriate monitoring. • Point-of-care ultrasound (POCUS) is an accessible and adaptable tool to assess neonatal and pediatric cardiac and/or respiratory failure at bedside. What is New: • In this review, we discussed the use of POCUS to monitor and manage at bedside neonatal and pediatric patients supported with ECMO. • We explored the potential use of POCUS during all phases of ECMO support: pre-ECMO assessment, ECMO candidacy evaluation, daily evaluation of heart, lung and brain function, detection and troubleshooting of major complications, and weaning from ECMO support.
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Affiliation(s)
- Stefania Bianzina
- Pediatric Anaesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Roberta Iacobelli
- Area of Cardiac Surgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Yigit Guner
- Pediatric Surgery, Children's Hospital of Orange County and University of California Irvine, Orange, CA, USA
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Rigotti C, Zannin E, Dellacà RL, Ventura ML. Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants. Pediatr Res 2024; 95:1022-1027. [PMID: 37857847 DOI: 10.1038/s41390-023-02829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND We investigated whether combining lung ultrasound scores (LUSs) and respiratory system reactance (Xrs) measured by respiratory oscillometry explains the severity of lung disease better than individual parameters alone. METHODS We performed a prospective observational study in very preterm infants. Forced oscillations (10 Hz) were applied using a neonatal mechanical ventilator (Fabian HFOi, Vyaire). We used the simultaneous respiratory severity score (RSS = mean airway pressure × FIO2) as a primary outcome. We built linear mixed-effect models to assess the relationship between Xrs z-score, LUS and RSS and compared nested models using the likelihood ratio test (LRT). RESULTS We enrolled 61 infants (median (Q1, Q3) gestational age = 30.00 (26.86, 31.00) weeks) and performed 243 measurements at a postnatal age of 26 (13, 41) days and postmenstrual age of 33.14 (30.46, 35.86) weeks. Xrs z-score and LUS were independently associated with simultaneous RSS (p < 0.001 for both). The model including Xrs and LUS explained the RSS significantly better than Xrs (p value LRT < 0.001) or LUS alone (p value LRT < 0.001). CONCLUSIONS Combining LUS and Xrs z-score explains the severity of lung disease better than each parameter alone and has the potential to improve the understanding of the underlying pathophysiology. IMPACT Combining respiratory system reactance by oscillometry and lung ultrasound score explains the respiratory support requirement (e.g., proxy of the severity of lung disease) significantly better than each parameter alone. We assessed the relationship between lung ultrasound and respiratory system reactance in very preterm infants for the first time. Combining respiratory oscillometry and lung ultrasound has the potential to improve the understanding of respiratory pathophysiology.
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Affiliation(s)
- Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Raffaele L Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Wu HL, Zhou SJ, Chen XH, Cao H, Zheng YR, Chen Q. Lung ultrasound score for monitoring the withdrawal of extracorporeal membrane oxygenation on neonatal acute respiratory distress syndrome. Heart Lung 2024; 63:9-12. [PMID: 37717371 DOI: 10.1016/j.hrtlng.2023.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/21/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is considered an efficient and life-saving treatment for neonatal severe acute respiratory distress syndrome (ARDS). Bedside lung ultrasound (LUS) is an attractive and feasible method for evaluating neonatal ARDS. OBJECTIVE To evaluate the value of LUS score at veno-arterial (V-A) ECMO withdrawal in neonatal patients with severe acute ARDS. METHODS A retrospective preliminary study was conducted in our cardiac intensive care unit from June 2021 to June 2022. Eight severe ARDS neonates who received V-A ECMO were enroled in this study. LUS was measured daily during ECMO and when weaning off ECMO. The relationships between the LUS score and ECMO parameters (blood flow and the sweep gas of FiO2) were assessed. RESULTS (1) There was a significant improvement in LUS score by ECMO treatment. And, various diagnostic signs of lung ultrasound were detected during ECMO, including pulmonary edema (7 neonates) and lung consolidation (4 neonates), followed by pleural effusion (1 neonate) and bilateral white lung (1 neonate). (2) A total of 12 trials for weaning off ECMO were carried out, of which four failed, but all eight neonates finally succeeded in passing the weaning trial. LUS score of 21 or less was defined as a cut-off value for predicting ECMO weaning success. During ECMO treatment, LUS score was positively correlated with ECMO blood flow (r = 0.866, P < 0.05). CONCLUSIONS LUS can be used to evaluate the various lung diagnostic signs in ARDS neonatal patients during ECMO treatment, and the LUS score under ECMO treatment decreases over time. The reduction in LUS score is associated with lower ECMO blood flow. LUS score is regarded as a predictor of ECMO weaning success.
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Affiliation(s)
- Hong-Lin Wu
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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Qin YJ, Zhang YQ, Chen Q, Wang Y, Li SY. Effect of high-frequency oscillation on reduction of atelectasis in perioperative patients: a prospective randomized controlled study. Ann Med 2023; 55:2272720. [PMID: 37874665 PMCID: PMC10836273 DOI: 10.1080/07853890.2023.2272720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Atelectasis affects approximately 90% of anaesthetized patients, with laparoscopic surgery and pneumoperitoneum reported to exacerbate this condition. High-frequency oscillation therapy applies continuous positive pressure pulses to oscillate the airway, creating a pressure difference in small airways obstructed by secretions. This process helps reduce peak airway pressure, open small airways, and decrease atelectasis incidence, while also facilitating respiratory tract clearance. This study examines the efficacy of high-frequency oscillation on reduction of atelectasis in laparoscopic cholecystectomy (LC) patients under general anaesthesia, evaluated using lung ultrasound. METHODS Sixty-four patients undergoing laparoscopic cholecystectomy were randomly divided into a control group and a high-frequency oscillation (HFO) group. Both groups underwent total intravenous anaesthesia under invasive arterial monitoring. The HFO group received a 10-minute continuous high-frequency oscillation therapy during surgery, while the control group received no intervention. Lung ultrasound evaluations were performed three times: five minutes post-intubation (T1), at the end of the surgery (T2), and before leaving the Post-Anaesthesia Care Unit (PACU; T3). Blood gas analysis was performed twice: prior to induction with no oxygen supply and before PACU discharge (oxygen supply off). RESULTS The HFO group displayed a significantly lower incidence of atelectasis at T3 (57.5% vs. 90.3%, OR 6.88, 95%CI (1.74 to 27.24)) compared to the control group. Moreover, the HFO group's PaO2 levels remained consistent with baseline levels before PACU discharge, unlike the control group. Although there was no significant difference in LUS scores between the groups at T1 (8.56 ± 0.15 vs. 8.19 ± 0.18, p = 0.1090), the HFO group had considerably lower scores at T2 (13.41 ± 0.17 vs.7.59 ± 0.17, p < 0.01) and T3 (13.72 ± 0.14 vs.7.25 ± 0.21, p < 0.01). CONCLUSION Our study indicates that high-frequency oscillation effectively reduces atelectasis in patients undergoing laparoscopic cholecystectomy. Additionally, it can mitigate the decline in oxygen partial pressure associated with atelectasis.
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Affiliation(s)
- Yuan-jun Qin
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yun-qian Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qi Chen
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Si-yuan Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
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Thatch KA, Kays DW. Advances in pulmonary management and weaning from ECLS. Semin Pediatr Surg 2023; 32:151329. [PMID: 37866170 DOI: 10.1016/j.sempedsurg.2023.151329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion on the various strategies and advances utilized by pediatric ECLS specialists today. ECMO patients require continual monitoring, serial gasses and radiographs, near-infrared spectroscopy (NIRS - to monitor oxygen delivery to regional tissue beds), and more quality ECLS directed care. As the foundation to lung recovery, good EMCO closely monitors ECLS flow rates, sweep gasses, and membrane lung function. Mixed venous oxygen saturation (Sv02) greater than 65% indicates good oxygen delivery and sweep gas adjustments maintain PaCO2 of 40-45 mm Hg. Lung recovery ventilatory settings do not fully rest the lungs but maintain normal or nontoxic pressure and oxygen levels. Neonatal recovery settings are PIP (cm H20) of 15-20, PEEP of 5-10, ventilator rate of 12-20 and an inspiratory time of 0.5-1 s, and FiO2 of 0.3-0.5. Pediatric recovery settings are PIP (cm H20) < 25, PEEP of 5-15, ventilator rate of 10-20 and an inspiratory time of 0.8-1 s, and FiO2 of <0.5. Some studies demonstrate a higher recovery PEEP level decreases duration of ECMO, but do not demonstrate a mortality difference. Multiple adjunctive therapies such as surfactant, routine pulmonary clearance and respiratory physiotherapy, iNO, prone positioning, bronchoscopy, POCUS, CT imaging, and extubation or "awake ECLS" can significantly affect pulmonary recovery. Patience is necessary as lung recovery may take weeks or even months on the nontoxic settings. On these settings, dynamic recovery will be revealed by improvement in tidal volume, minute ventilation and radiographic pulmonary aeration, prompting discussion about weaning. When this pulmonary compliance recovery becomes evident, decreasing ECLS flow while also decreasing circuit FiO2 and/or sweep gas are common components to ECMO weaning strategies.
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Affiliation(s)
- Keith A Thatch
- Department of Pediatric Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, USA.
| | - David W Kays
- Department of Pediatric Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Wang R, Zhou M, Man Y, Zhu Y, Ding W, Liu Q, Sun B, Yan L, Zhang Y, Zhou H, Wang L. Lung ultrasound to evaluate pulmonary changes in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation: a retrospective study. BMC Anesthesiol 2023; 23:181. [PMID: 37231331 DOI: 10.1186/s12871-023-02134-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate the value of lung ultrasound (LUS) in patients with cardiogenic shock treated by venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS A retrospective study was conducted in Xuzhou Central Hospital from September 2015 to April 2022. Patients with cardiogenic shock who received VA-ECMO treatment were enrolled in this study. The LUS score was obtained at the different time points of ECMO. RESULTS Twenty-two patients were divided into a survival group (n = 16) and a nonsurvival group (n = 6). The intensive care unit (ICU) mortality was 27.3% (6/22). The LUS scores in the nonsurvival group were significantly higher than those in the survival group after 72 h (P < 0.05). There was a significant negative correlation between LUS scores and PaO2/FiO2 and LUS scores and pulmonary dynamic compliance(Cdyn) after 72 h of ECMO treatment (P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of T72-LUS was 0.964 (95% CI 0.887 ~ 1.000, P < 0.01). CONCLUSION LUS is a promising tool for evaluating pulmonary changes in patients with cardiogenic shock undergoing VA-ECMO. TRIAL REGISTRATION The study had been registered in the Chinese Clinical Trial Registry(NO.ChiCTR2200062130 and 24/07/2022).
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Affiliation(s)
- Rongguo Wang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Meiyan Zhou
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yuanyuan Man
- Department of Respiratory, Xuzhou Central Hospital, Xuzhou, China
| | - Yangzi Zhu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Wenping Ding
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Qian Liu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Bin Sun
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Li Yan
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yan Zhang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Hai Zhou
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Liwei Wang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China.
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Theerawit P, Pukapong P, Sutherasan Y. Relationship between lung ultrasound and electrical impedance tomography as regional assessment tools during PEEP titration in acute respiratory distress syndrome caused by multi-lobar pneumonia: a pilot study. J Clin Monit Comput 2023; 37:889-897. [PMID: 36592267 DOI: 10.1007/s10877-022-00962-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/10/2022] [Indexed: 01/03/2023]
Abstract
Acute respiratory distress syndrome (ARDS) caused by multilobar pneumonia (MLP) is markedly different from typical ARDS in pathology, imaging characteristics, and lung mechanics. Regional lung assessment is required. We aimed to analyze the relationship between two regional assessment tools, lung ultrasound (LUS) and electrical impedance tomography (EIT) during positive end-expiratory pressure (PEEP) titration, and determine an appropriate PEEP level. We conducted a prospective study of patients with ARDS caused by MLP with PaO2/FiO2 < 150 mmHg. All subjects were equipped with two EIT belts connected with a single EIT machine to measure upper and lower hemithorax impedance change alternatingly at each PEEP level. LUS score was simultaneously determined in chest wall regions corresponding to the EIT regions during PEEP titration. We acquired EIT and LUS data in eight regions of interest at seven PEEP levels in 12 subjects. Therefore, 672 pairs of data were obtained for analysis. There were significant relationships between LUS score and tidal impedance variation and pixel compliance (Cpix). The Spearman's rho between LUS score vs. tidal impedance variation and LUS score vs. the Cpix were - 0.142, P < 0.001, and - 0.195, P < 0.001, respectively. The relationship between the LUS score and Cpix remained the same at every PEEP level but did not reach statistical significance. The individual's mean expected PEEP by LUS was similar to the EIT [10.33(± 1.67) vs. 10.33(± 1.44) cm H2O, P = 0.15]. Regarding the MLP, the LUS scores were associated with EIT parameters, and LUS scores might proof helpful for finding individual PEEP settings in MLP.
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Affiliation(s)
- Pongdhep Theerawit
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pirun Pukapong
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yuda Sutherasan
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
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11
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Shkurka E, Nolan W. Physiotherapy-led lung ultrasound in neonatal extra-corporeal membrane oxygenation: A case-study. Perfusion 2022:2676591221094410. [DOI: 10.1177/02676591221094410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a growing body of evidence to support the use of point of care lung ultrasound (LUS) in adult patients receiving extra-corporeal membrane oxygenation (ECMO). However, literature supporting the use of LUS in neonatal and paediatric ECMO patients is limited. We report the use of physiotherapy-led LUS in a neonatal ECMO patient. The baby required veno-arterial ECMO for long-segment tracheal stenosis and presented with complete right lung collapse. In this situation real time, bedside imaging enabled timely and specific physiotherapy treatment to be implemented. LUS also allowed immediate reassessment and subsequent improvement to be determined. This negated the requirement for an additional, pre-surgery chest X-ray, reducing radiation exposure. This case-study highlights LUS as an important tool for health professionals caring for neonatal and paediatric ECMO patients. Future research should include further development of population specific LUS scoring systems.
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Affiliation(s)
- Emma Shkurka
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wendy Nolan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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12
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Wang ZJ, Trill J, Tan LL, Chang WJ, Zhang Y, Willcox M, Xia RY, Jiang Y, Moore M, Liu JP, Hu XY. Reynoutria japonica Houtt for Acute Respiratory Tract Infections in Adults and Children: A Systematic Review. Front Pharmacol 2022; 13:787032. [PMID: 35281919 PMCID: PMC8911541 DOI: 10.3389/fphar.2022.787032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction: Respiratory tract infections (RTIs) are a major cause of morbidity and mortality in some high-risk groups including children and older adults. There is evidence that Chinese herbal medicine has an effect on RTIs. Reynoutria japonica Houtt (better known under its synonym Fallopia japonica (Houtt.) Ronse Decr.) (F. japonica), a commonly used Chinese herbal medicine, has a high content of resveratrol and glycosides. In traditional Chinese medicine theory, F. japonica has the effect of clearing heat in the body, improving blood and qi circulation, eliminating phlegm, and relieving cough, so it may have an effect on RTIs. Methods: This systematic review was registered under PROSPERO CRD42020188604. Databases were searched for randomized controlled trials of F. japonica as a single herb, or as a component of a complex herbal formula for RTIs. Quality of methodology was assessed by two reviewers independently using the Cochrane Risk of Bias Tool. The primary outcome was symptom improvement rate. The secondary outcome measures were fever clearance time, Murray lung injury score and incidence of adverse effects. The extracted data were pooled and meta-analysed by RevMan 5.3 software. Results: Eight RCTs with 1,123 participants with acute RTIs were included in this systematic review, and all the RCTs used F. japonica as part of a herbal mixture. Only one included trial used F. japonica in a herbal mixture without antibiotics in the treatment group. The findings showed that herbal remedies that included F. japonica could increase the symptom improvement rate (risk ratio 1.14, 95% confidence intervals [1.09, 1.20], I2 = 0%, p < 0.00001, n = 7 trials, 1,013 participants), shorten fever duration, reduce Murray lung injury score and did not increase adverse events (RR 0.33, 95% CI [0.11, 1.00], I2 = 0%, p = 0.05, n = 5 trials, 676 participants). Conclusion: There is limited but some evidence that F. japonica as part of a herbal mixture may be an effective and safe intervention for acute RTIs in clinical practice. In future studies it would be preferable to evaluate the effectiveness and safety of using F. japonica without antibiotics for acute RTIs.
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Affiliation(s)
- Zhi-Jie Wang
- Department of Oncology, Shanxi Province Hospital of Tradition Chinese Medicine, Taiyuan, China
- The Institute of Shanxi Traditional Chinese Medicine, Taiyuan, China
| | - Jeanne Trill
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lin-Lin Tan
- The Institute of Shanxi Traditional Chinese Medicine, Taiyuan, China
| | - Wen-Jing Chang
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Merlin Willcox
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ru-Yu Xia
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Jiang
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Michael Moore
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jian-Ping Liu
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xiao-Yang Hu, ; Jian-Ping Liu,
| | - Xiao-Yang Hu
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- *Correspondence: Xiao-Yang Hu, ; Jian-Ping Liu,
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13
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Zhang Y, Wang C, Wang F, Shi J, Dou J, Shan Y, Sun T, Zhou Y. Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome Received Extracorporeal Membrane Oxygenation: A Prospective Cohort Study. Front Pediatr 2022; 10:798855. [PMID: 35419318 PMCID: PMC8995848 DOI: 10.3389/fped.2022.798855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the prognostic value of the lung ultrasound (LUS) score in patients with pediatric acute respiratory distress syndrome (pARDS) who received extracorporeal membrane oxygenation (ECMO). METHODS A prospective cohort study was conducted in a pediatric intensive care unit (PICU) of a tertiary hospital from January 2016 to June 2021. The severe pARDS patients who received ECMO were enrolled in this study. LUS score was measured at initiation of ECMO (LUS-0 h), then at 24 h (LUS-24 h), 48 h (LUS-48 h), and 72 h (LUS-72 h) during ECMO, and when weaned from ECMO (LUS-wean). The value of LUS scores at the first 3 days of ECMO as a prognostic predictor was analyzed. RESULTS Twenty-nine children with severe pARDS who received ECMO were enrolled with a median age of 26 (IQR 9, 79) months. The median duration of ECMO support was 162 (IQR 86, 273) h and the PICU mortality was 31.0% (9/29). The values of LUS-72 h and LUS-wean were significantly lower in survivors than that in non-survivors (both P < 0.001). Daily fluid balance volume during the first 3 days of ECMO support were strongly correlated with LUS score [1st day: r = 0.460, P = 0.014; 2nd day: r = 0.540, P = 0.003; 3rd day: r = 0.589, P = 0.001]. The AUC of LUS-72 h for predicting PICU mortality in these patients was 1.000, and the cutoff value of LUS-72 h was 24 with a sensitivity of 100.0% and a specificity of 100.0%. Furthermore, patients were stratified in two groups of LUS-72 h ≥ 24 and LUS-72 h < 24. Consistently, PICU mortality, length of PICU stay, ratio of shock, vasoactive index score value, and the need for continuous renal replacement therapy were significantly higher in the group of LUS-72 h ≥ 24 than in the group of LUS-72 h < 24 (all P < 0.05). CONCLUSION Lung ultrasound score is a promising tool for predicting the prognosis in patients with ARDS under ECMO support. Moreover, LUS-72 h ≥ 24 is associated with high risk of PICU mortality in patients with pARDS who received ECMO.
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Affiliation(s)
- Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaying Dou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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14
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Biasucci DG, Loi B, Centorrino R, Raschetti R, Piastra M, Pisapia L, Consalvo LM, Caricato A, Grieco DL, Conti G, Antonelli M, De Luca D. Ultrasound-assessed lung aeration correlates with respiratory system compliance in adults and neonates with acute hypoxemic restrictive respiratory failure: an observational prospective study. Respir Res 2022; 23:360. [PMID: 36529748 PMCID: PMC9759805 DOI: 10.1186/s12931-022-02294-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung ultrasound allows lung aeration to be assessed through dedicated lung ultrasound scores (LUS). Despite LUS have been validated using several techniques, scanty data exist about the relationships between LUS and compliance of the respiratory system (Crs) in restrictive respiratory failure. Aim of this study was to investigate the relationship between LUS and Crs in neonates and adults affected by acute hypoxemic restrictive respiratory failure, as well as the effect of patients' age on this relationship. METHODS Observational, cross-sectional, international, patho-physiology, bi-center study recruiting invasively ventilated, adults and neonates with acute respiratory distress syndrome (ARDS), neonatal ARDS (NARDS) or respiratory distress syndrome (RDS) due to primary surfactant deficiency. Subjects without lung disease (NLD) and ventilated for extra-pulmonary conditions were recruited as controls. LUS, Crs and resistances (Rrs) of the respiratory system were measured within 1 h from each other. RESULTS Forty adults and fifty-six neonates were recruited. LUS was higher in ARDS, NARDS and RDS and lower in control subjects (overall p < 0.001), while Crs was lower in ARDS, NARDS and RDS and higher in control subjects (overall p < 0.001), without differences between adults and neonates. LUS and Crs were correlated in adults [r = - 0.86 (95% CI - 0.93; - 0.76), p < 0.001] and neonates [r = - 0.76 (95% CI - 0.85; - 0.62), p < 0.001]. Correlations remained significant among subgroups with different causes of respiratory failure; LUS and Rrs were not correlated. Multivariate analyses confirmed the association between LUS and Crs both in adults [B = - 2.8 (95% CI - 4.9; - 0.6), p = 0.012] and neonates [B = - 0.045 (95% CI - 0.07; - 0.02), p = 0.001]. CONCLUSIONS Lung aeration and compliance of the respiratory system are significantly and inversely correlated irrespective of patients' age. A restrictive respiratory failure has the same ultrasound appearance and mechanical characteristics in adults and neonates.
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Affiliation(s)
- Daniele Guerino Biasucci
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Barbara Loi
- grid.460789.40000 0004 4910 6535Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris-Saclay University Hospitals, Public Assistance – Paris Hospitals, Paris, France
| | - Roberta Centorrino
- grid.460789.40000 0004 4910 6535Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris-Saclay University Hospitals, Public Assistance – Paris Hospitals, Paris, France
| | - Roberto Raschetti
- grid.460789.40000 0004 4910 6535Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris-Saclay University Hospitals, Public Assistance – Paris Hospitals, Paris, France
| | - Marco Piastra
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Luca Pisapia
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Ludovica Maria Consalvo
- grid.414818.00000 0004 1757 8749Anesthesiology and Intensive Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anselmo Caricato
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy ,grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart in Rome, Milan, Italy
| | - Domenico Luca Grieco
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Giorgio Conti
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy ,grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart in Rome, Milan, Italy
| | - Massimo Antonelli
- grid.414603.4Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy ,grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart in Rome, Milan, Italy
| | - Daniele De Luca
- grid.460789.40000 0004 4910 6535Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris-Saclay University Hospitals, Public Assistance – Paris Hospitals, Paris, France ,grid.460789.40000 0004 4910 6535Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France
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15
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Zhang X, Fu Y, Yue G, Yang S, Ju R. Lung ultrasound for the assessment of lung recruitment in neonates with massive pneumothorax during extracorporeal membrane oxygenation: a case report. J Artif Organs 2021; 25:163-169. [PMID: 34292454 DOI: 10.1007/s10047-021-01287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/13/2021] [Indexed: 01/02/2023]
Abstract
Bedside lung ultrasound may be an effective method for the assessment of lung recruitment in newborns with extracorporeal membrane oxygenation (ECMO). We report a case of a neonate who had severe hypoxemia with persistent pulmonary hypertension and massive pneumothorax due to meconium aspiration syndrome and was treated with ECMO. Positive pressure mechanical ventilation resulted in persistent massive air leakage from the disrupted pulmonary tissue. When ECMO was initiated, a "total lung rest" ventilation strategy was used to facilitate healing of the lung rupture and absorption of the pneumothorax. After complete absorption of the pneumothorax, lung recruitment was performed by progressively increasing the positive end-expiratory pressure under the guidance of lung ultrasound. Bedside lung ultrasound was successfully used to assess pneumothorax absorption and improvement of pulmonary inflammation and successfully guided the recruitment of collapsed alveoli and the withdrawal of ECMO.
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Affiliation(s)
- Xiaolong Zhang
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
| | - Yiyong Fu
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Guang Yue
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Sheng Yang
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
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16
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Taniguchi H, Ohta S, Honzawa H, Takahashi K, Iwashita M, Abe T, Takeuchi I. Usefulness of serial lung ultrasound for a severe COVID-19 patient on extracorporeal membrane oxygenation. Respir Med Case Rep 2021; 33:101383. [PMID: 33717868 PMCID: PMC7939979 DOI: 10.1016/j.rmcr.2021.101383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Computed tomography (CT) is the most reliable method to evaluate the progression of COVID-19 pneumonitis. However, in a pandemic, transportation of critically ill invasively ventilated patients to radiology facilities is challenging, especially for those on extracorporeal membrane oxygenation (ECMO). Notably, lung ultrasound (LUS) is a favored alternative imaging modality due to its ease of use at the point of care, which reduces the infectious risk of exposure and transmission; repeatability; absence of radiation exposure; and low cost. We demonstrated that serial LUS compares favorably with other imaging modalities in terms of usefulness for evaluating lung aeration and recovery in an ECMO-managed COVID-19 patient.
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Affiliation(s)
- Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Souichi Ohta
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Hiroshi Honzawa
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Kouhei Takahashi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Masayuki Iwashita
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Japan
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17
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Yaoting WMD, Huihui CMD, Ruizhong YMD, Jingzhi LMDP, Ji-Bin LMD, Chen L, Chengzhong PMD. Point-of-Care Ultrasound: New Concepts and Future Trends. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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