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Flexible Bronchoscopy in Pediatric Venovenous Extracorporeal Membrane Oxygenation

Elizabeth A Rosner1, Jessica L Parker2, Caryn Vandenberg2

  • 1Helen DeVos Children's Hospital, Grand Rapids, Michigan. Elizabeth.rosner@helendevoschildrens.org.

Respiratory Care
|March 30, 2022
PubMed

Insights

Flexible bronchoscopy (FB) can be safely performed on pediatric patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Early FB may improve outcomes, including reduced ventilator days and shorter intensive care unit stays.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Extracorporeal Life Support

Background:

  • Pediatric patients with acute respiratory distress syndrome (ARDS) may require venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support.
  • Lung recruitment maneuvers, such as flexible bronchoscopy (FB), can be beneficial during recovery for these patients.

Purpose of the Study:

  • To assess the clinical course and outcomes of pediatric patients who underwent flexible bronchoscopy (FB) while on VV-ECMO for ARDS.

Main Methods:

  • Secondary analysis of a retrospective multi-center cohort study involving 204 pediatric patients on VV-ECMO.
  • Data collected from 10 United States pediatric academic quaternary care centers.

Main Results:

  • Flexible bronchoscopy (FB) improved tidal volume and dynamic compliance in pediatric patients on VV-ECMO.
  • Early FB was associated with more ECMO-free days, more ventilator-free days, and shorter ICU length of stay compared to late FB.
  • Mortality was lower in patients who underwent FB (27.1%) compared to those who did not (40%).

Conclusions:

  • Flexible bronchoscopy (FB) can be safely performed in pediatric patients on VV-ECMO, even when anticoagulated, with a low incidence of complications.
  • Early FB intervention may be particularly beneficial for improving patient outcomes during VV-ECMO support for ARDS.
Abstract

Keywords:
flexible bronchoscopy; venovenous ECMOlung recruitmentmechanical ventilationpediatric ARDSpulmonary clearance

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