scholarly journals An Approach to Refractory Hypoxemia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Garrido, MD ◽  
◽  
Evan Nardone, MD ◽  
Mark Mallozzi, MD ◽  
◽  
...  
Keyword(s):  
Refractory Hypoxemia

scholarly journals Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jose R. Navas-Blanco ◽  
Sofia A. Lifgren ◽  
Roman Dudaryk ◽  
Jeffrey Scott ◽  
Matthias Loebe ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Body Surface ◽  
Large Body ◽  
Morbidly Obese ◽  
Cardiovascular Collapse ◽  
Cardiovascular Failure ◽  
Fluid Removal ◽  
Novel Approach ◽  
Refractory Hypoxemia ◽  
Oxygenation Status

Abstract Background The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas. Case presentation We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock. Conclusions Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.

Refractory hypoxemia associated with neonatal pulmonary disease: The use and limitations of tolazoline

1979 ◽  
Vol 95 (4) ◽  
pp. 595-599 ◽  
Author(s):  
David K. Stevenson ◽  
David S. Kasting ◽  
Robert A. Darnall ◽  
Ronald L. Ariagno ◽  
John D. Johnson ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Refractory Hypoxemia

scholarly journals Utilization of Airway Pressure Release Ventilation as a Rescue Strategy in COVID-19 Patients: A Retrospective Analysis

2021 ◽  
pp. 088506662110308
Author(s):  
Omar Mahmoud ◽  
Deep Patadia ◽  
James Salonia
Keyword(s):  
Retrospective Analysis ◽  
Airway Pressure ◽  
Minute Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Airway Pressure Release Ventilation ◽  
Inspiratory Time ◽  
Predicted Body Weight ◽  
Pressure Release ◽  
Refractory Hypoxemia ◽  
Pressure Release Ventilation

Background: Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by prolonged inspiratory time and high mean airway pressure. Several studies have demonstrated that APRV can improve oxygenation and lung recruitment in patients with Acute Respiratory Distress Syndrome (ARDS). Although most patients with COVID-19 meet the Berlin criteria for ARDS, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. To date, no studies investigating APRV in this patient population have been published. The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia. Methods: We conducted a retrospective analysis of patients admitted with COVID-19 requiring invasive mechanical ventilation who were treated with a trial of APRV for refractory hypoxemia. PaO2/FIO2 (P/F ratio), ventilatory ratio and ventilation outputs before and during APRV were compared. Results: APRV significantly improved the P/F ratio and decreased FIO2 requirements. PaCO2 and ventilatory ratio were also improved. There was an increase in tidal volume per predicted body weight during APRV and a decrease in total minute ventilation. On multivariate analysis, higher inspiratory to expiratory ratio (I: E) and airway pressure were associated with greater improvement in P/F ratio. Conclusions: APRV may improve oxygenation, alveolar ventilation and CO2 clearance in patients with COVID-19 and refractory hypoxemia. These effects are more pronounced with higher airway pressure and inspiratory time.

scholarly journals Multiple Pregnancy and Oligoamnios as Risk Factors for Refractory Hypoxemia in Very Premature Newborns

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 254A-254A
Author(s):  
Jean C Roze ◽  
Caroline Hurtin ◽  
Christelle Gras ◽  
Cecile Bosher ◽  
Thierry Debillon
Keyword(s):  
Risk Factors ◽  
Multiple Pregnancy ◽  
Premature Newborns ◽  
Refractory Hypoxemia

Extracorporeal membrane oxygenation in Jehovah’s Witness patients: Case report, literature review, and summary of recommendations

Perfusion ◽  
2021 ◽  
pp. 026765912110477
Author(s):  
Abrahán Mera ◽  
Eduard Argudo ◽  
María Martínez-Martínez ◽  
Clara Palmada ◽  
Camilo Bonilla ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Influenza A ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Membrane Oxygenation ◽  
Influenza A H1n1 ◽  
Refractory Hypoxemia ◽  
Venovenous Ecmo ◽  
H1n1 Pneumonia ◽  
Witness Patient

Extracorporeal Membrane Oxygenation (ECMO) is commonly associated with a high blood transfusion requirement. Jehovah’s Witness patients present a particular challenge. The impossibility of transfusing blood cells and starting anticoagulation treatment are common contraindications for this supportive measure. Here we report the case of a Jehovah’s Witness patient with refractory hypoxemia due to influenza A H1N1 pneumonia who required venovenous ECMO for 11 days. We describe the use of a bloodless approach to reduce the waste of blood, avoiding anticoagulation, and improving red blood cell production. We then summarize the current literature on the use of ECMO in Jehovah’s Witness patients and, finally, we propose some recommendations for their management.

Temporary Veno-Venous ECMO for Acute Respiratory Illness in Pediatric Berlin Heart Patient

2021 ◽  
pp. 215013512110628
Author(s):  
Madeleine L. Townsend ◽  
Sara Sadat-Hossieny ◽  
Samir Q. Latifi ◽  
Gerard Boyle ◽  
Alistair Phillips
Keyword(s):  
Mechanical Circulatory Support ◽  
Severe Heart Failure ◽  
Respiratory Illness ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Unique Case ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Refractory Hypoxemia

We report the unique case of a 2-year-old male with severe heart failure requiring mechanical circulatory support with a left ventricular assist device, who developed adenovirus pneumonitis infection requiring veno-venous extracorporeal membrane oxygenation (ECMO) support. He progressed to acute respiratory failure and refractory hypoxemia despite intubation with maximum respiratory support. The patient was placed on ECMO with improvement in lung function over four days with subsequent successful decannulation. During the ECMO run, anticoagulation required escalation given the increased circuit surface area. Patient has since recovered and undergone heart transplantation.

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