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Severe Lung Dysfunc...
Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation
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- Falk, Lars (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
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- Lidegran, Marika (author)
- Karolinska Institutet,Karolinska University Hospital
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- Diaz Ruiz, Sandra (author)
- Karolinska Institutet,Karolinska Institute,Lund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Radiology Diagnostics, Malmö,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Karolinska University Hospital
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- Hultman, Jan (author)
- Karolinska Institute,Karolinska University Hospital
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- Broman, Lars Mikael (author)
- Karolinska Institute,Karolinska University Hospital
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(creator_code:org_t)
- 2024
- 2024
- English.
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In: Journal of Clinical Medicine. - 2077-0383. ; 13:4
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- extracorporeal membrane oxygenation
- prognosis
- prognostication
- prolonged ECMO
- pulmonary blood flow
- sepsis
- septic shock
- tidal volume
Publication and Content Type
- art (subject category)
- ref (subject category)
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