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NS High FiO2 35 (16%) High tidal volumes and high ventilator pressures 173 (81%) Don't know 7 (3%) In situations when maximal SaO2 achievable is low (±85%) or when FiO2 requirements are high, do you assess indices of tissue oxygenation?
Venovenous extracorporeal membrane oxygenation (VV-ECMO) has become a widely accepted treatment option for life-threatening acute respiratory failure when mechanical ventilation (MV) and adjunctive measures fail to provide adequate gas exchange or when lung rest cannot be achieved due to high ventilator requirements [1, 2].
The patient died on the seventh day because of poor lung function despite high ventilator support (Fig. 1).
Nondependent parts of the lungs are therefore often overventilated and have barotrauma induced by high ventilator pressure [ 5].
One included few of the infants at highest risk and used relatively high ventilator pressures with CV [ 15].
Among key findings of the most prominent clinical investigations is the association between high ventilator tidal volumes and worsening lung injury [ 7- 11].
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Special practices are recommended only for units with persistently high ventilator-associated pneumonia rates despite high rates of adherence to the strategies suggested above.
This, in turn, will lead to higher ventilator settings prolonged ventilation with potentially high oxygen load [ 9] and increase the probability of BPD.
Results: PROM20 infants had an increased acute respiratory morbidity (higher ventilator settings and increased incidence of hypoxemia, hypercapnia, and pulmonary hypertension) and a trend to more air leaks.
These findings indicate the need for higher ventilator loads to maintain minimum oxygenation, which would be caused by a more severe and established lung injury in veno-venous ECMO patients.
Placement of the nebulizer closer to the patient (between the ET tube and the "Y" connector) avoids potential dilution of the aerosol by the higher ventilator airflow rates.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com