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[Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia].
Zhonghua Er Ke Za Zhi. 2009 Nov; 47(11):852-5.ZE

Abstract

OBJECTIVE

To report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia.

METHOD

A seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%.

RESULTS

In management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding.

CONCLUSION

ECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child.

Links

Publisher Full Text

Authors+Show Affiliations

Xu X
Department of PICU, Bayi Children's Hospital Affiliated to the Military General Hospital of Beijing, the People's Liberation Army, Beijing 100700, China.
Feng ZC
No affiliation info available
Hong XY
No affiliation info available
Fu S
No affiliation info available
Zhou GX
No affiliation info available
Guo WZ
No affiliation info available
Yin X
No affiliation info available

MeSH

ChildExtracorporeal Membrane OxygenationHeart FailureHumansMalePneumoniaResearch ReportRespiration Disorders

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

chi

PubMed ID

20078999

Citation

Xu, Xuan, et al. "[Extracorporeal Membrane Oxygenation for Severe Acute Respiratory and Heart Failure in a Child With Severe Pneumonia]." Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, vol. 47, no. 11, 2009, pp. 852-5.
Xu X, Feng ZC, Hong XY, et al. [Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia]. Zhonghua Er Ke Za Zhi. 2009;47(11):852-5.
Xu, X., Feng, Z. C., Hong, X. Y., Fu, S., Zhou, G. X., Guo, W. Z., & Yin, X. (2009). [Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia]. Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, 47(11), 852-5.
Xu X, et al. [Extracorporeal Membrane Oxygenation for Severe Acute Respiratory and Heart Failure in a Child With Severe Pneumonia]. Zhonghua Er Ke Za Zhi. 2009;47(11):852-5. PubMed PMID: 20078999.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia]. AU - Xu,Xuan, AU - Feng,Zhi-chun, AU - Hong,Xiao-yang, AU - Fu,Song, AU - Zhou,Geng-xu, AU - Guo,Wen-zhi, AU - Yin,Xiu, PY - 2010/1/19/entrez PY - 2010/1/19/pubmed PY - 2011/1/12/medline SP - 852 EP - 5 JF - Zhonghua er ke za zhi = Chinese journal of pediatrics JO - Zhonghua Er Ke Za Zhi VL - 47 IS - 11 N2 - OBJECTIVE: To report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia. METHOD: A seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%. RESULTS: In management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding. CONCLUSION: ECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child. SN - 0578-1310 UR - https://www.unboundmedicine.com/medline/citation/20078999/[Extracorporeal_membrane_oxygenation_for_severe_acute_respiratory_and_heart_failure_in_a_child_with_severe_pneumonia]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&issn=0578-1310&year=2009&vol=47&issue=11&fpage=852 DB - PRIME DP - Unbound Medicine ER -