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Diffuse pulmonary opacification in infants undergoing extracorporeal membrane oxygenation: clinical and pathologic
Insights
Chest X-rays in infants on extracorporeal membrane oxygenation (ECMO) show diffuse pulmonary opacification. This finding accurately reflects decreased lung compliance and volumes in severe respiratory failure.
Area of Science:
- Pediatric critical care medicine
- Pulmonary imaging
- Neonatology
Background:
- Diffuse pulmonary opacification is a common radiographic finding in infants with severe respiratory failure requiring extracorporeal membrane oxygenation (ECMO).
- The relationship between radiographic findings, clinical severity, and lung mechanics in these patients is not fully understood.
Purpose of the Study:
- To correlate the degree of pulmonary opacification on chest radiographs with clinical severity (ECMO flow rate) and dynamic lung compliance in infants undergoing ECMO.
- To identify pathological changes associated with ECMO therapy and severe respiratory failure.
Main Methods:
- Retrospective review of chest radiographs and clinical records of 18 infants treated with ECMO.
- Radiographic scoring to quantify pulmonary opacification.
- Correlation analysis with ECMO flow rates and dynamic lung compliance measurements.
Main Results:
- A decreasing radiographic score (improving opacification) correlated well with increasing lung compliance and decreasing ECMO flow rates.
- Pathological findings were primarily related to the underlying respiratory condition and intensive respiratory support.
- Diffuse pulmonary hemorrhage was noted in one patient; no other specific ECMO-related pathological features were identified.
Conclusions:
- Pulmonary opacification on chest radiographs in infants on ECMO accurately reflects reduced lung compliance and volumes.
- These changes are attributed to hyaline membrane formation, pulmonary edema, and atelectasis secondary to severe respiratory failure.
- ECMO therapy itself, apart from potential bleeding complications, does not appear to cause distinctive pathological lung changes.
Abstract:
Diffuse pulmonary opacification is commonly seen on chest radiographs from infants with severe respiratory failure treated with extracorporeal membrane oxygenation (ECMO). The chest radiographs and clinical records of 18 such infants were reviewed to determine the correlation among degree of abnormality on chest radiograph (as determined by a radiographic score), clinical severity of disease (as measured by ECMO requirements [ECMO flow rate]), and dynamic lung compliance determinations. Increasing lung compliance and decreasing ECMO flow rates correlated well with decreasing (improving) radiographic score. Pathologic changes were mainly those associated with intensive respiratory support and the underlying pulmonary condition. One patient had diffuse pulmonary hemorrhage. Other than bleeding, no distinctive pathologic features could be attributed to therapy with ECMO. We conclude that the degree of pulmonary opacification seen in infants undergoing ECMO therapy is an accurate reflection of markedly decreased lung compliance and lung volumes caused by hyaline membrane formation, pulmonary edema, and atelectasis associated with the various causes of severe respiratory failure.