Reducing time on for extra-corporeal membrane oxygenation for adults with H1N1 pneumonia with the use of the Volume Diffusive Respirator

Abstract Background The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO....

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Bibliographic Details
Published in:The American journal of surgery 2013-05, Vol.205 (5), p.500-504
Main Authors: Michaels, Andrew J., M.D, Hill, Jonathan G., M.D, Long, William B., M.D, Sperley, Bernie P., D.O, Young, Brian P., M.D, Park, Paulene K., M.D, Rycus, Peter T., B.S, Bartlett, Robert H., M.D
Format: Article
Language:English
Subjects:
Adult
ARDS
Carbon dioxide
Combined Modality Therapy
ELSO
Extracorporeal Membrane Oxygenation
Female
H1N1
High-Frequency Ventilation - instrumentation
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human - therapy
Lungs
Male
Middle Aged
Patients
Pneumonia
Pneumonia, Viral - therapy
Recruitment
Registries
Respiratory distress syndrome
Respiratory therapy
Surgery
Swine flu
Time Factors
Treatment Outcome
VDR
Ventilation
Ventilators, Mechanical
Volume Diffusive Respirator
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Summary:Abstract Background The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO. Methods Adults who survived ECMO were compared regarding time on ECMO for those treated with the Volume Diffusive Respirator (VDR) or with conventional “lung rest.” The VDR delivered 500 percussions/min, with tidal pressures of 24/12 cm H2 O and a fraction of inspired oxygen of .4 at 15 beats/min. Results There were no differences between the study patients (n = 7) and the Extracorporeal Life Support Organization cohort (n = 150) regarding age, pre-ECMO ventilator days, pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen, or survival after lung recovery. Patients treated with VDR required ECMO support for a shorter duration (mean, 193.29 ± 35.71 vs 296.63 ± 18.17 hours; P = .029). Conclusions These data suggest that the VDR enhanced pulmonary recovery from severe H1N1 pneumonia in adults. Shorter times on ECMO may improve the risk/benefit and cost/benefit ratios associated with ECMO care.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2013.01.024