| 1. |
- Falk, Lars, et al.
(författare)
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Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation
- 2024
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Ingår i: Journal of Clinical Medicine. - 2077-0383. ; 13:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support.
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| 2. |
- Konradsen, Jon R, et al.
(författare)
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Predicting asthma morbidity in children using proposed markers of Th2-type inflammation.
- 2015
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 26:8, s. 772-779
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessment of inflammation is becoming a common practice in the clinical work-up of children with persistent asthma. Biomarkers of Th2-mediated inflammation include blood eosinophils (B-Eos), exhaled nitric oxide (FeNO), total serum IgE (S-IgE), and serum periostin. The aim of this study was to investigate the associations between asthma morbidity and increased levels of these biomarkers in pediatric asthma.METHODS: School-age children (n = 96) with various manifestations of persistent asthma were included in this nationwide Swedish study. The protocol included the asthma control test, Juniper's quality of life questionnaire (QoL), assessment of pulmonary function, bronchial hyperresponsiveness, height-adjusted FeNO, blood sampling for S-IgE, B-Eos, and periostin, and high-resolution computed tomography (HRCT) of the lungs.RESULTS: Children with both high levels of height-adjusted FeNO and B-Eos were younger (p = 0.001), had more often severe asthma (p = 0.015), were more allergic (p < 0.001), had a reduced asthma control (p = 0.035), reduced QoL (p = 0.035), more exacerbations (p = 0.004), reduced FEV1/FVC (p = 0.001), and increased bronchial hyperresponsiveness (p < 0.001) as well as greater bronchial wall thickening on HRCT (p = 0.022) compared to those with low levels of both biomarkers. Grouping children according to high and low serum periostin levels did not relate to differences in clinical characteristics and biomarkers.CONCLUSIONS: Assessment of both local and systemic Th2-mediated inflammation by the analysis of easily attainable biomarkers such as exhaled NO and blood eosinophils has a high predictive value for the identification of children with the highest asthma morbidity. Adjusting FeNO values according to the individual child's height increases the clinical usefulness of this biomarker.
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| 3. |
- Lidegran, Marika
(författare)
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Advanced radiological imaging in patients treated with Extracorporeal Memebrane Oxygenation
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal membrane oxygenation (ECMO) is the use of a modified heart-lung machine to support life during severe acute cardiac and/or respiratory failure. Patients on ECMO are at high risk for complications due to the severe underlying disease and to the ECMO procedure itself. The clinical evaluation of patients on ECMO may be unreliable and the diagnostic value of portable bedside imaging is limited. Advanced radiographic methods like CT are rarely used during ongoing ECMO and MRI has previously never been tested. There is also lack of knowledge of the long term respiratory function in survivors of severe acute respiratory distress syndrome (ARDS) and ECMO. The frequency, indications, findings and effect on treatment of CT performed in patients during ECMO therapy, at the ECMO department Karolinska University Hospital, were retrospectively reviewed. Paper I: It was found that CT had been performed in nearly half of the treated patients, most often due to suspected complications. In 57% of 104 CT occasions clinically significant findings were revealed. There were no complications to the CT examinations. Paper II: In 25% of 118 performed thoraco-abdominal CT scans clinically important complications, dominated by hemothorax, massive pleural fluid, pericardial tamponade and abdominal hemorrhages, were revealed. The majority resulted in surgery or percutaneous drainage during ECMO, with high survival rates. Accordingly, the role of chest and abdominal CT during ECMO is to identify patients with complications where urgent invasive therapy is essential, when bedside imaging has been inconclusive. Paper III: In 37% of 123 pediatric and adult patients on ECMO, intracranial hemorrhage or infarction was revealed with CT during the treatment. Large hemorrhages or pronounced general edema were reasons to discontinue the ECMO treatment, neurosurgical intervention was motivated in a few patients and in patients with lesions with expected fair prognosis, ECMO was continued with high survival. Thus, the main value of cranial CT is in differentiating patients who have no CNS complications or complications with good prognosis from those with poor prognosis where the treatment should be withdrawn. Paper IV: Twenty-one adult long term survivors of severe ARDS and ECMO were studied in a follow-up program including CT of the lungs, pulmonary function tests and a dedicated questionnaire for evaluation of respiratory problems. It was found that lung parenchymal changes suggestive of fibrosis, pulmonary function abnormalities and subjective respiratory symptoms can be found more then one year after ECMO-treated severe ARDS. However, the impairments are most often mild and the majority has good physical and social functioning. Paper V: In an experimental study, the ECMO system was tested for magnetic resonance imaging (MRI) compatibility, using a pig model. The study showed that MRI can safely be performed in living subjects. on ECMO with high quality images. In the future this may have an impact, especially on early diagnosis and treatment of cerebral complications in patients on ECMO.
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| 4. |
- Lidegran, Marika, et al.
(författare)
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Cranial CT for diagnosis of intracranial complications in adult and pediatric patients during ECMO : Clinical benefits in diagnosis and treatment
- 2007
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Ingår i: Academic Radiology. - Netherlands : Elsevier BV. - 1076-6332 .- 1878-4046. ; 14:1, s. 62-71
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE AND OBJECTIVES: To evaluate the clinical utility of cranial computed tomography (CT) in pediatric and adult patients during ongoing extracorporeal membrane oxygenation (ECMO) treatment from acute respiratory failure and to assess the frequency of intracranial hemorrhage (ICH) and infarction during the treatment. MATERIALS AND METHODS: The medical records of 123 consecutive patients, 54 children (ages 3 months-17 years) and 69 adults (ages 18-62 years), treated with ECMO over a 10-year period were searched for cranial CT performed during ECMO. Indications for CT, CT findings, impact on clinical management, and patient outcome were noted. In addition, all CT scans were reviewed for the frequency of ICH or infarction. RESULTS: Seventy-eight patients had cranial CT while on ECMO. ICH or cerebral infarction were detected in 45 (37%) of the 123 patients. Eighteen patients (15%) had focal hemorrhage, 11 (9%) focal infarction, and 16 (13%) general brain edema. In 16 of the 45 patients, the CT findings were decisive to withdraw the ECMO treatment. Five patients were weaned from ECMO, and in four patients the findings motivated cranial surgery during ECMO. In the remaining 20 patients with less extended intracranial pathology, the ECMO treatment was continued with high survival. CONCLUSION: Cranial CT has an important role during ECMO treatment to reveal or exclude severe intracranial complications where ECMO treatment should be discontinued. Less severe complications have a favorable prognosis with continued treatment. Our study suggests an underreporting of intracranial complications in adults and pediatric patients on ECMO because of low utilization of neuroimaging.
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