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Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims...

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Autores principales: Nunes, Liane Brescovici, Mendes, Pedro Vitale, Hirota, Adriana Sayuri, Barbosa, Edzangela Vasconcelos, Maciel, Alexandre Toledo, Schettino, Guilherme Pinto Paula, Costa, Eduardo Leite Vieira, Azevedo, Luciano Cesar Pontes, Park, Marcelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935134/
https://www.ncbi.nlm.nih.gov/pubmed/24626942
http://dx.doi.org/10.6061/clinics/2014(03)05
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author Nunes, Liane Brescovici
Mendes, Pedro Vitale
Hirota, Adriana Sayuri
Barbosa, Edzangela Vasconcelos
Maciel, Alexandre Toledo
Schettino, Guilherme Pinto Paula
Costa, Eduardo Leite Vieira
Azevedo, Luciano Cesar Pontes
Park, Marcelo
author_facet Nunes, Liane Brescovici
Mendes, Pedro Vitale
Hirota, Adriana Sayuri
Barbosa, Edzangela Vasconcelos
Maciel, Alexandre Toledo
Schettino, Guilherme Pinto Paula
Costa, Eduardo Leite Vieira
Azevedo, Luciano Cesar Pontes
Park, Marcelo
author_sort Nunes, Liane Brescovici
collection PubMed
description OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1) optimization of extracorporeal membrane oxygenation blood flow; 2) identification of recirculation and cannula repositioning if necessary; 3) optimization of residual lung function and consideration of blood transfusion; 4) diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5) optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.
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spelling pubmed-39351342014-03-01 Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support Nunes, Liane Brescovici Mendes, Pedro Vitale Hirota, Adriana Sayuri Barbosa, Edzangela Vasconcelos Maciel, Alexandre Toledo Schettino, Guilherme Pinto Paula Costa, Eduardo Leite Vieira Azevedo, Luciano Cesar Pontes Park, Marcelo Clinics (Sao Paulo) Clinical Science OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1) optimization of extracorporeal membrane oxygenation blood flow; 2) identification of recirculation and cannula repositioning if necessary; 3) optimization of residual lung function and consideration of blood transfusion; 4) diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5) optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2014-03 /pmc/articles/PMC3935134/ /pubmed/24626942 http://dx.doi.org/10.6061/clinics/2014(03)05 Text en Copyright © 2014 Hospital das Clínicas da FMUSP http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
Nunes, Liane Brescovici
Mendes, Pedro Vitale
Hirota, Adriana Sayuri
Barbosa, Edzangela Vasconcelos
Maciel, Alexandre Toledo
Schettino, Guilherme Pinto Paula
Costa, Eduardo Leite Vieira
Azevedo, Luciano Cesar Pontes
Park, Marcelo
Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title_full Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title_fullStr Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title_full_unstemmed Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title_short Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
title_sort severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935134/
https://www.ncbi.nlm.nih.gov/pubmed/24626942
http://dx.doi.org/10.6061/clinics/2014(03)05
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