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Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure.
Pediatr Crit Care Med. 2003 Jul; 4(3):291-8.PC

Abstract

OBJECTIVES

To describe a single center's experience with the primary use of venovenous cannulation for supporting pediatric acute respiratory failure patients with extracorporeal membrane oxygenation (ECMO).

DESIGN

Retrospective chart review of all patients receiving extracorporeal life support at a single institution.

SETTING

Pediatric intensive care unit at a tertiary care children's hospital.

PATIENTS

Eighty-two patients between the ages of 2 wks and 18 yrs with severe acute respiratory failure.

INTERVENTIONS

ECMO for acute respiratory failure.

MEASUREMENTS AND MAIN RESULTS

From January 1991 until April 2002, 82 pediatric patients with acute respiratory failure were cannulated for ECMO support. Median duration of ventilation before ECMO was 5 days (range, 1-17 days). Sixty-eight of these patients (82%) initially were placed on venovenous ECMO. Fourteen patients were initiated and remained on venoarterial support, including six in whom venovenous cannulae could not be placed. One patient was converted from venovenous to venoarterial support due to inadequate oxygenation. Venoarterial patients had significantly greater alveolar-arterial oxygen gradients and lower PaO(2)/FIO(2) ratios than venovenous patients (p <.03). Fifty-five of 81 venovenous patients received additional drainage cannulae (46 of 55 with an internal jugular cephalad catheter). Thirty-five percent of venovenous patients and 36% of venoarterial patients required at least one vasopressor infusion at time of cannulation (p = nonsignificant); vasopressor dependence decreased over the course of ECMO in both groups. Median duration on venovenous ECMO for acute hypoxemic respiratory failure was 218 hrs (range, 24-921). Venovenous ECMO survivors remained cannulated for significantly shorter time than nonsurvivors did (median, 212 vs. 350 hrs; p =.04). Sixty-three of 82 ECMO (77%) patients survived to discharge-56 of 68 venovenous ECMO (81%) and nine of 14 venoarterial ECMO (64%).

CONCLUSIONS

Venovenous ECMO can effectively provide adequate oxygenation for pediatric patients with severe acute respiratory failure receiving ECMO support. Additional cannulae placed at the initiation of venovenous ECMO could be beneficial in achieving flow rates necessary for adequate oxygenation and lung rest.

Authors+Show Affiliations

Nemours Children's Clinic, Arnold Palmer Hospital for Children and Women, Orlando, FL 32806, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12831409

Citation

Pettignano, Robert, et al. "Primary Use of the Venovenous Approach for Extracorporeal Membrane Oxygenation in Pediatric Acute Respiratory Failure." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 4, no. 3, 2003, pp. 291-8.
Pettignano R, Fortenberry JD, Heard ML, et al. Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2003;4(3):291-8.
Pettignano, R., Fortenberry, J. D., Heard, M. L., Labuz, M. D., Kesser, K. C., Tanner, A. J., Wagoner, S. F., & Heggen, J. (2003). Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 4(3), 291-8.
Pettignano R, et al. Primary Use of the Venovenous Approach for Extracorporeal Membrane Oxygenation in Pediatric Acute Respiratory Failure. Pediatr Crit Care Med. 2003;4(3):291-8. PubMed PMID: 12831409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary use of the venovenous approach for extracorporeal membrane oxygenation in pediatric acute respiratory failure. AU - Pettignano,Robert, AU - Fortenberry,James D, AU - Heard,Micheal L, AU - Labuz,Michele D, AU - Kesser,Kenneth C, AU - Tanner,April J, AU - Wagoner,Scott F, AU - Heggen,Judith, PY - 2003/7/2/pubmed PY - 2003/11/5/medline PY - 2003/7/2/entrez SP - 291 EP - 8 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 4 IS - 3 N2 - OBJECTIVES: To describe a single center's experience with the primary use of venovenous cannulation for supporting pediatric acute respiratory failure patients with extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective chart review of all patients receiving extracorporeal life support at a single institution. SETTING: Pediatric intensive care unit at a tertiary care children's hospital. PATIENTS: Eighty-two patients between the ages of 2 wks and 18 yrs with severe acute respiratory failure. INTERVENTIONS: ECMO for acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: From January 1991 until April 2002, 82 pediatric patients with acute respiratory failure were cannulated for ECMO support. Median duration of ventilation before ECMO was 5 days (range, 1-17 days). Sixty-eight of these patients (82%) initially were placed on venovenous ECMO. Fourteen patients were initiated and remained on venoarterial support, including six in whom venovenous cannulae could not be placed. One patient was converted from venovenous to venoarterial support due to inadequate oxygenation. Venoarterial patients had significantly greater alveolar-arterial oxygen gradients and lower PaO(2)/FIO(2) ratios than venovenous patients (p <.03). Fifty-five of 81 venovenous patients received additional drainage cannulae (46 of 55 with an internal jugular cephalad catheter). Thirty-five percent of venovenous patients and 36% of venoarterial patients required at least one vasopressor infusion at time of cannulation (p = nonsignificant); vasopressor dependence decreased over the course of ECMO in both groups. Median duration on venovenous ECMO for acute hypoxemic respiratory failure was 218 hrs (range, 24-921). Venovenous ECMO survivors remained cannulated for significantly shorter time than nonsurvivors did (median, 212 vs. 350 hrs; p =.04). Sixty-three of 82 ECMO (77%) patients survived to discharge-56 of 68 venovenous ECMO (81%) and nine of 14 venoarterial ECMO (64%). CONCLUSIONS: Venovenous ECMO can effectively provide adequate oxygenation for pediatric patients with severe acute respiratory failure receiving ECMO support. Additional cannulae placed at the initiation of venovenous ECMO could be beneficial in achieving flow rates necessary for adequate oxygenation and lung rest. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/12831409/Primary_use_of_the_venovenous_approach_for_extracorporeal_membrane_oxygenation_in_pediatric_acute_respiratory_failure_ L2 - https://doi.org/10.1097/01.PCC.0000074261.09027.E1 DB - PRIME DP - Unbound Medicine ER -