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Pulmonary management during extracorporeal membrane oxygenation.
M Keszler1, K N Subramanian, Y A Smith
1Department of Pediatrics, Georgetown University Medical Center, Washington, DC 20007.
Critical Care Medicine
|June 1, 1989
Summary
High positive end-expiratory pressure (PEEP) during extracorporeal membrane oxygenation (ECMO) in newborns safely prevents lung injury and improves outcomes. This approach reduces ECMO duration and lung opacification, promoting faster recovery.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Traditional extracorporeal membrane oxygenation (ECMO) lung management uses low pressures, risking lung injury.
- Rapid pressure weaning in severe lung injury can cause pulmonary opacification and volume loss.
Purpose of the Study:
- To investigate if high positive end-expiratory pressure (PEEP) can prevent lung deterioration during ECMO.
- To evaluate the safety and efficacy of high PEEP in newborns undergoing ECMO.
Main Methods:
- Forty-six newborns with refractory respiratory failure received ECMO with 8-14 cm H2O PEEP.
- Ventilator settings included peak pressure 20-24 cm H2O, rate 10-15/min, and FiO2 0.21.
- Chest X-rays monitored pulmonary opacification and lung expansion.
Main Results:
- Survival to discharge was 89% (41/46 patients).
- ECMO duration was significantly reduced compared to national averages (82.4 vs. 117.5 hours).
- High PEEP (≥12 cm H2O) was associated with minimal lung opacification and deterioration.
Conclusions:
- High PEEP during ECMO is safe and effective in preventing lung injury in newborns.
- Elevated PEEP levels (12-14 cm H2O) promote lung recovery and reduce ECMO duration.
- This strategy improves outcomes for neonates with severe respiratory failure requiring ECMO.