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Early treatment with arteriovenous extracorporeal lung assist and high-frequency oscillatory ventilation in a case of severe acute respiratory distress syndrome.
Acta Anaesthesiol Scand. 2007 Jul; 51(6):766-9.AA

Abstract

BACKGROUND

Lung protective ventilation can reduce mortality in acute respiratory distress syndrome (ARDS). However, many patients with severe ARDS remain hypoxemic and more aggressive ventilation is necessary to maintain sufficient gas exchange. Pumpless arteriovenous extracorporeal lung assist (av-ECLA) has been shown to remove up to 95% of the systemic CO(2) production, thereby allowing ventilator settings and modes prioritizing oxygenation and lung protection. High-frequency oscillatory ventilation (HFOV) is an alternative form of ventilation that may improve oxygenation while limiting the risk of further lung injury by using extremely small tidal volumes (VT).

METHODS

We discuss the management of a patient suffering from severe ARDS as a result of severe bilateral lung contusions and pulmonary aspiration.

RESULTS

Severe ARDS developed within 4 h after intensive care unit admission. Conventional mechanical ventilation (CV) with high-airway pressures and low VT failed to improve gas exchange. Av-ECLA was initiated to achieve a less aggressive ventilation strategy. VT was reduced to 2-3 ml/kg, but oxygenation did not improve and airway pressures remained high. HFOV (8-10 Hz) was started using a recruitment strategy and oxygenation improved within 2 h. After 5 days, the patient was switched back to CV uneventfully and av-ECLA was removed after 8 days.

CONCLUSION

The combination of two innovative treatment modalities resulted in rapid stabilization and improvement of gas exchange during severe ARDS refractory to conventional lung protective ventilation. During av-ECLA, extremely high oscillatory frequencies were used minimizing the risk of baro- and volutrauma.

Authors+Show Affiliations

Department of Anaesthesiology, University of Wuerzburg, Wuerzburg, Germany. muellenbac_r@klinik.uni-wuerzburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17425618

Citation

Muellenbach, R M., et al. "Early Treatment With Arteriovenous Extracorporeal Lung Assist and High-frequency Oscillatory Ventilation in a Case of Severe Acute Respiratory Distress Syndrome." Acta Anaesthesiologica Scandinavica, vol. 51, no. 6, 2007, pp. 766-9.
Muellenbach RM, Wunder C, Nuechter DC, et al. Early treatment with arteriovenous extracorporeal lung assist and high-frequency oscillatory ventilation in a case of severe acute respiratory distress syndrome. Acta Anaesthesiol Scand. 2007;51(6):766-9.
Muellenbach, R. M., Wunder, C., Nuechter, D. C., Smul, T., Trautner, H., Kredel, M., Roewer, N., & Brederlau, J. (2007). Early treatment with arteriovenous extracorporeal lung assist and high-frequency oscillatory ventilation in a case of severe acute respiratory distress syndrome. Acta Anaesthesiologica Scandinavica, 51(6), 766-9.
Muellenbach RM, et al. Early Treatment With Arteriovenous Extracorporeal Lung Assist and High-frequency Oscillatory Ventilation in a Case of Severe Acute Respiratory Distress Syndrome. Acta Anaesthesiol Scand. 2007;51(6):766-9. PubMed PMID: 17425618.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early treatment with arteriovenous extracorporeal lung assist and high-frequency oscillatory ventilation in a case of severe acute respiratory distress syndrome. AU - Muellenbach,R M, AU - Wunder,C, AU - Nuechter,D C, AU - Smul,T, AU - Trautner,H, AU - Kredel,M, AU - Roewer,N, AU - Brederlau,J, Y1 - 2007/04/10/ PY - 2007/4/12/pubmed PY - 2007/9/7/medline PY - 2007/4/12/entrez SP - 766 EP - 9 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 51 IS - 6 N2 - BACKGROUND: Lung protective ventilation can reduce mortality in acute respiratory distress syndrome (ARDS). However, many patients with severe ARDS remain hypoxemic and more aggressive ventilation is necessary to maintain sufficient gas exchange. Pumpless arteriovenous extracorporeal lung assist (av-ECLA) has been shown to remove up to 95% of the systemic CO(2) production, thereby allowing ventilator settings and modes prioritizing oxygenation and lung protection. High-frequency oscillatory ventilation (HFOV) is an alternative form of ventilation that may improve oxygenation while limiting the risk of further lung injury by using extremely small tidal volumes (VT). METHODS: We discuss the management of a patient suffering from severe ARDS as a result of severe bilateral lung contusions and pulmonary aspiration. RESULTS: Severe ARDS developed within 4 h after intensive care unit admission. Conventional mechanical ventilation (CV) with high-airway pressures and low VT failed to improve gas exchange. Av-ECLA was initiated to achieve a less aggressive ventilation strategy. VT was reduced to 2-3 ml/kg, but oxygenation did not improve and airway pressures remained high. HFOV (8-10 Hz) was started using a recruitment strategy and oxygenation improved within 2 h. After 5 days, the patient was switched back to CV uneventfully and av-ECLA was removed after 8 days. CONCLUSION: The combination of two innovative treatment modalities resulted in rapid stabilization and improvement of gas exchange during severe ARDS refractory to conventional lung protective ventilation. During av-ECLA, extremely high oscillatory frequencies were used minimizing the risk of baro- and volutrauma. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/17425618/Early_treatment_with_arteriovenous_extracorporeal_lung_assist_and_high_frequency_oscillatory_ventilation_in_a_case_of_severe_acute_respiratory_distress_syndrome_ L2 - https://doi.org/10.1111/j.1399-6576.2007.01303.x DB - PRIME DP - Unbound Medicine ER -