Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children

Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children

153 ABSTRACTS ration in three (4%) patients, gastric hemorrhage in three (4%) gastrointestinal perforation in one (I%), and prolonged ileus in 12 (1...

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153

ABSTRACTS

ration in three (4%) patients, gastric hemorrhage in three (4%) gastrointestinal perforation in one (I%), and prolonged ileus in 12 (18%). In addition, gastric dilatation rendered abdominal examination difficult and delayed peritoneal lavage. Acute gastric dilatation after trauma is frequent in our rural trauma center. Early placement of a nasogastric tube in the absence of a clear contraindication is strongly supported in the management of multiply injured patients. (Reprinted with permission.)

morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates, Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both. (Reprinted with permission.) Serotonin Hypoxia

Receptor in Porcine

Blockade Improves ARDS. Sielafl TD.

man HJ, et al. Surg Changes

in lntrathoracic

End-Expiratory Procedures.

Pressure

Bonnet

Pressures

Induced

Ventilation

F, Fischler

After

M. Dubois

by

Cardiac

Positive Surgical

CL, et al.

The consequences of controlled ventilation with positive end-expiratory pressure (PEEP) were studied, after cardiac surgical procedures, in two groups of patients supposed to have different lung and chest wall mechanical properties. The first group included 6 patients who had undergone coronary artery graft surgical procedures (CGS). The second group included 5 patients who had undergone a mitral valve replacement (MVR). Postoperatively, static lung and chest wall compliance was measured by stepwise inflation and deflation of the thorax. Esophageal, pericardial, and pleural pressures were then measured, and cardiac output was determined while PEEP was increased from 0 to 20 cm H,O. Lung and chest wall compliance values sharply decreased in MVR patients. This accounts for the lower values for pleural and pericardial pressures in this group than in the CGS patient group, but the transmission of airway pressure was identical in the two groups when PEEP was increased. The decrease in cardiac output induced by PEEP was similar in the two groups. The results suggest that the opposing influences of lung and chest wall compliance on airway pressure transmission could at least partly explain the hemodynamic effects of PEEP in patients in whom the mechanical properties of the lung and thorax are impaired. PEEP ventilation should be used cautiously in patients suspected of having thoracic rigidity. (Reprinted with permission.) Extracorporeal Cardiac Failure

Membrane in Infants

ED, Falterman 1987.

KW,

Oxygenation and Children.

et al. J Thorac

for Respiratory

and

Redman CR, Graves Cardiovasc Surg 93: 199,

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. Extracorporeal membrane oxygenation has proved to be a useful modality in salvaging high-risk neonates with minimal

Res 43:118,

Cardiac

Output

Kellum

JM.

and

Suger-

1987.

The effects of the serotonin receptor blocker, ketanserin, were studied in a procine Pseudomonas adult respiratory distress syndrome model. Swine, weighing 14-30 kg, were anesthetized and ventilated with 0.5 FiO, and 5 cm H,O positive end expiratory pressure. Three groups were studied: saline control (C, n = 9). continuous intravenous Pseudomonas aeruginosa. 5.0 x 10’ CFU/kg/min (Ps, n = 8), and Pseudomonas and intravenous ketanserin, 0.2 mg/kg, given at 20 and 120 min after the onset of the Pseudomonas infusion (KET, n = 5). Pulmonary arterial (PAP) and systemic arterial (SAP) pressures, cardiac index (CI), thermal Cardio-Green extravascular lung water (EVLW), pulmonary albumin flux (slope index, SI), arterial blood gases, and whole blood serotonin levels were measured and pulmonary shunt and pulmonary (PVRI) and systemic (SVRI) vascular resistance indices were calculated. At 3 hr the Ps group demonstrated significant (P < 0.05) increases in PAP (34 k 1 vs C I3 + 2 mm Hg), EVLW (14.4 f 2.2 vs C 4.3 t 1.2 ml/kg), SI (2.05 + 0.23 x 10 3 vs C 0.38 + 0.09 x IO-’ U/min), pulmonary shunt (67 t 15% vs C 9 2 3%), PVRI (1599 * 89 vs C 184 t 14 dyn . cm ~‘1 and SVRI (4542 ? 774 vs C 2087 t- 129 m*), dyn 1 set . cm~‘/m’) and decreases in CI (0.9 i 0.1 L/ min/m’ vs C 2.8 k 0.2 L/min/m2), P80, (93 -r 17 Torr vs C 203 f 15 Torr) and arterial blood serotonin concentration (23.5 + 13% decrease from basal). Treatment with ketanserin was associated with maintenance of PaO, (KET 207 i: 5 mm Hg vs C 203 k I5 mm Hg), pulmonary shunt (KET 8 + 3% vs C 9 * 3%). and CI (Ket 2.3 * 0.1 L/min/m’ vs C 2.8 + 0.2 L/mitt/m’) at control levels and attenuated the Pseudomonas-induced increase in PVRI (873 k 37 vs Ps 1599 t 89 dyn . set . cm-‘/m’) and SVRI (2089 + 287 vs Ps 4542 + 774 dyn . set . cm-‘/m’), but did not alter the development of pulmonary edema. These data indicate that serotonin plays a role in the development of the V/Q mismatch and arterial hypoxemia observed in this model by a mechanism independent of changes in microvascular injury and permeability and was probably a result of reduced peripheral bronchiolar constriction. (Reprinted with permission.) Effect

of Furosemide

Pulmonary

Surg

Edema.

Res 41:141,

on

Fully

Rusch 1986.

VW,

Established

Artman

Low

L, Cheney

Pressure

FW.

It has been shown that furosemide, via nondiuretic vascular effects, reduces pulmonary shunt and lung water during the development of oleic acid permeability edema. We studied this effect in a fully established stable model of oleic acid permeability edema. Sixteen anesthetized mongrel dogs,

J