RESUMEN
BACKGROUND: No consensus exists on the optimal settings of mechanical ventilation during veno-venous extracorporeal membrane oxygenation (ECMO). Our aim was to describe how mechanical ventilation and related interventions are managed by adult ECMO centres. METHODS: A cross-sectional, multi-centre, international survey of 173 adult respiratory ECMO centres. The survey was generated through an iterative process and assessed for clarity, content and face validity. RESULTS: One hundred thirty-three centres responded (76.8%). Pressure control was the most commonly used mechanical ventilation mode (64.4%). Although the median PEEP was 10 cmH2O, 22.6% set PEEP <10 cmH2O and 15.5% used 15-20 cmH2O. In 63% of centres PEEP was fixed and not titrated. Recruitment maneuvres, were never used in 34.1% of centres, or used daily in 13.2%. Centres reported using either a "lung rest" (45.7%), or an "open lung" strategy (44.2%). Only 24.8% used chest CT to guide mechanical ventilation. Adjunctive treatments were never or occasionally used. Only 10% of centres extubated patients on ECMO, mainly in more experienced centres. 71.3% of centres performed tracheostomy on ECMO, with large variability in timing (most frequent on days 6-10). Only 27.1% of ECMO centres had a protocol for mechanical ventilation on ECMO. CONCLUSION: We found large variability in ventilatory practices during ECMO. The clinicians' training background and the centres' experience had no influence on the approach to ventilation. This survey shows that well conducted studies are necessary to determine the best practice of mechanical ventilation during ECMO and its impact on patient outcome.
Asunto(s)
Manejo de la Vía Aérea/métodos , Oxigenación por Membrana Extracorpórea/métodos , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Adulto , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , TraqueostomíaRESUMEN
The case presented in this report is of a female patient who suffered recurrent transudative right pleural effusions, due to a giant benign intrathoracic goitre. The latter caused compression of the brachiocephalic vein, which is a very rare cause of pleural fluid accumulation. Magnetic resonance imaging played a crucial diagnostic role.
Asunto(s)
Venas Braquiocefálicas , Bocio Subesternal/complicaciones , Derrame Pleural/etiología , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Derrame Pleural/diagnóstico , RecurrenciaRESUMEN
The inflammatory pseudotumour of the lung is a rare and non-malignant neoplasm, which can be asymptomatic or characterized by variable clinical expressions. This report refers to a case occurring in a young woman and presenting as a persistent airway obstructive syndrome. With regard to histopathologic characterization, the present case can be classified as a fibrous histiocytic subtype.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Granuloma de Células Plasmáticas del Pulmón/complicaciones , Adulto , Obstrucción de las Vías Aéreas/patología , Bronquios/patología , Femenino , Humanos , Granuloma de Células Plasmáticas del Pulmón/patologíaRESUMEN
A case of tracheal rupture due to orotracheal intubation performed for anaesthesiological procedures is described. It is very likely that this rare complication was favoured by some anatomical factors, which were responsible for a difficult intubation. Tracheal rupture was diagnosed by endoscopy and treated by a decompressive tracheostomy.