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Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure.
Crit Care Med. 1996 Apr; 24(4):679-82.CC

Abstract

OBJECTIVE

To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure.

DESIGN

Descriptive study.

SETTING

A tertiary pediatric referral center.

PATIENTS

Children aged 1 month to 18 yrs treated with ECLS for acute respiratory failure at University of Michigan Hospitals from November 1982 to June 1993. All patients aged 1 month to 18 yrs who received ECLS for acute respiratory failure were included. Patients who received ECLS primarily for cardiac support or who had a diagnosis of congenital gastrointestinal malformation (i.e. congenital diaphragmatic hernia) were excluded.

INTERVENTIONS

ECLS for severe pediatric respiratory failure.

MEASUREMENTS AND MAIN RESULTS

Forty-nine children were treated at our center with ECLS for acute respiratory failure 36 (73%) survived. Ventilator settings immediately after decannulation from ECLS for survivors were as follows: FIO2 0.53 +/- 0.18 (SD); intermittent mandatory ventilation (IMV) 29.6 +/- 1.18 breaths/min, positive end-expiratory pressure 5.3 +/- 1.6 cm H2O, mean airway pressure 12.6 +/- 2.9 cm H2O, and peak inspiratory pressure 31.7 +/- 5.5 cm H2O. Arterial blood gas measurements at decannulation were PaO2 89.4 +/- 30.9 torr (11.9 +/- 4.1 kPa), PaCO2 43.7 +/- 9.7 torr (5.8 +/- 1.3 kPa), and pH 7.39 +/- 0.07. Twenty-four hours after decannulation, ventilator settings and arterial blood gas measurements were as follows: FIO2 0.42 +/- 0.14, IMV 27.4 +/- 13.5 breaths/min, positive end-expiratory pressure 5.2 +/- 1.6 cm H2O, mean airway pressure 12.0 +/- 3.4 cm H2O, peak inspiratory pressure 31.1 +/- 6.5 cm H2O, PaO2 77.0 +/- 16.9 torr (10.3 +/- 2.3 kPa), PaCO2 44.9 +/- 8.4 torr (6.0 +/- 1.1 kPa), and pH 7.40 +/- 0.07. Variables associated with oxygenation status (P[A-a]O2) and mean airway pressure (oxygenation index) improved during the immediate 24-hr period postbypass (p < .05).

CONCLUSIONS

Successful decannulation from ECLS for > 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechanical ventilation pressures for the postbypass recovering lung.

Authors+Show Affiliations

Section of Critical Care Medicine, University of Michigan Hospitals, Ann Arbor 48109-0243, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8612422

Citation

Moler, F W., et al. "Mechanical Ventilation and Arterial Blood Gas Measurements 24 Hours Postextracorporeal Life Support for Survivors of Pediatric Respiratory Failure." Critical Care Medicine, vol. 24, no. 4, 1996, pp. 679-82.
Moler FW, Palmisano JM, Custer JR, et al. Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure. Crit Care Med. 1996;24(4):679-82.
Moler, F. W., Palmisano, J. M., Custer, J. R., & Bartlett, R. H. (1996). Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure. Critical Care Medicine, 24(4), 679-82.
Moler FW, et al. Mechanical Ventilation and Arterial Blood Gas Measurements 24 Hours Postextracorporeal Life Support for Survivors of Pediatric Respiratory Failure. Crit Care Med. 1996;24(4):679-82. PubMed PMID: 8612422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure. AU - Moler,F W, AU - Palmisano,J M, AU - Custer,J R, AU - Bartlett,R H, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 679 EP - 82 JF - Critical care medicine JO - Crit Care Med VL - 24 IS - 4 N2 - OBJECTIVE: To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure. DESIGN: Descriptive study. SETTING: A tertiary pediatric referral center. PATIENTS: Children aged 1 month to 18 yrs treated with ECLS for acute respiratory failure at University of Michigan Hospitals from November 1982 to June 1993. All patients aged 1 month to 18 yrs who received ECLS for acute respiratory failure were included. Patients who received ECLS primarily for cardiac support or who had a diagnosis of congenital gastrointestinal malformation (i.e. congenital diaphragmatic hernia) were excluded. INTERVENTIONS: ECLS for severe pediatric respiratory failure. MEASUREMENTS AND MAIN RESULTS: Forty-nine children were treated at our center with ECLS for acute respiratory failure 36 (73%) survived. Ventilator settings immediately after decannulation from ECLS for survivors were as follows: FIO2 0.53 +/- 0.18 (SD); intermittent mandatory ventilation (IMV) 29.6 +/- 1.18 breaths/min, positive end-expiratory pressure 5.3 +/- 1.6 cm H2O, mean airway pressure 12.6 +/- 2.9 cm H2O, and peak inspiratory pressure 31.7 +/- 5.5 cm H2O. Arterial blood gas measurements at decannulation were PaO2 89.4 +/- 30.9 torr (11.9 +/- 4.1 kPa), PaCO2 43.7 +/- 9.7 torr (5.8 +/- 1.3 kPa), and pH 7.39 +/- 0.07. Twenty-four hours after decannulation, ventilator settings and arterial blood gas measurements were as follows: FIO2 0.42 +/- 0.14, IMV 27.4 +/- 13.5 breaths/min, positive end-expiratory pressure 5.2 +/- 1.6 cm H2O, mean airway pressure 12.0 +/- 3.4 cm H2O, peak inspiratory pressure 31.1 +/- 6.5 cm H2O, PaO2 77.0 +/- 16.9 torr (10.3 +/- 2.3 kPa), PaCO2 44.9 +/- 8.4 torr (6.0 +/- 1.1 kPa), and pH 7.40 +/- 0.07. Variables associated with oxygenation status (P[A-a]O2) and mean airway pressure (oxygenation index) improved during the immediate 24-hr period postbypass (p < .05). CONCLUSIONS: Successful decannulation from ECLS for > 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechanical ventilation pressures for the postbypass recovering lung. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/8612422/Mechanical_ventilation_and_arterial_blood_gas_measurements_24_hours_postextracorporeal_life_support_for_survivors_of_pediatric_respiratory_failure_ DB - PRIME DP - Unbound Medicine ER -