by Kurihara,
Chitaru; Walter, James M.; Singer, Benjamin D.; Cajigas, Hector; Shayan,
Shahriar; Al-Qamari, Abbas; DeCamp, Malcolm M.; Wunderink, Rich; Budinger, GR
Scott; Bharat, Ankit
Objectives:
Extracorporeal membrane oxygenation is increasingly used in the management of
severe acute respiratory distress syndrome. With extracorporeal membrane
oxygenation, select patients with acute respiratory distress syndrome can be
managed without mechanical ventilation, sedation, or neuromuscular blockade.
Published experience with this approach, specifically with attention to a
patient’s respiratory drive following cannulation, is limited.
Design: We
describe our experience with three consecutive patients with severe acute
respiratory distress syndrome supported with right jugular-femoral
configuration of venovenous extracorporeal membrane oxygenation without
therapeutic anticoagulation as an alternative to lung-protective mechanical
ventilation. Outcomes are reported including daily respiratory rate, vital
capacities, and follow-up pulmonary function testing.
Results: Following cannulation, patients were extubated
within 24 hours. During extracorporeal membrane oxygenation support, all
patients were able to maintain a normal respiratory rate and experienced steady
improvements in vital capacities. Patients received oral nutrition and
ambulated daily. At follow-up, no patients required supplemental oxygen.
Conclusions: Our
results suggest that venovenous extracorporeal membrane oxygenation can provide
a safe and effective alternative to lung-protective mechanical ventilation in
carefully selected patients. This approach facilitates participation in
physical therapy and avoids complications associated with mechanical
ventilation.
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