Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
Clinics
;
69(3): 173-178, 3/2014. tab, graf
Article
Dans Anglais
| LILACS
| ID: lil-703597
ABSTRACT
OBJECTIVE:
Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution.METHODS:
Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered 1) optimization of extracorporeal membrane oxygenation blood flow; 2) identification of recirculation and cannula repositioning if necessary; 3) optimization of residual lung function and consideration of blood transfusion; 4) diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5) optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output.CONCLUSION:
Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions. .
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Oxygénation extracorporelle sur oxygénateur à membrane
/
Hypoxie
Type d'étude:
Étude pronostique
Limites du sujet:
Adolescent
/
Adulte
/
Femelle
/
Humains
/
Mâle
langue:
Anglais
Texte intégral:
Clinics
Thème du journal:
Médicament
Année:
2014
Type:
Article
Pays d'affiliation:
Brésil
Institution/Pays d'affiliation:
Universidade de Sao Paulo/BR
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