Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities.
ECMO
acute lung injury
cytokine surge
refractory hypoxia
systemic inflammatory response
Journal
Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures)
ISSN: 2393-1809
Titre abrégé: J Crit Care Med (Targu Mures)
Pays: Poland
ID NLM: 101706934
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
09
07
2020
accepted:
27
10
2020
entrez:
1
11
2021
pubmed:
2
11
2021
medline:
2
11
2021
Statut:
epublish
Résumé
There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk's Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.
Identifiants
pubmed: 34722898
doi: 10.2478/jccm-2020-0040
pii: jccm-2020-0040
pmc: PMC8519372
doi:
Types de publication
Journal Article
Langues
eng
Pagination
6-13Informations de copyright
© 2021 Kiran Batra, Manish Mohanka, Srinivas Bollineni, Vaidehi Kaza, Prabhakar Rajiah, Yin Xi, Amy Hackmann, Michael Wait, Fernando Torres, Amit Banga, published by Sciendo.
Déclaration de conflit d'intérêts
Conflict of interest None to declare.
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