PURPOSE: Extracorporeal membrane oxygenation (ECMO) can support oxygenation and carbon dioxide elimination in severe lung failure. Usually it is accompanied by controlled mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is a new mode of ventilation triggered by the diaphragmatic electrical activity and controlled by the patient's respiratory centre, which may allow a close interaction between ventilation and extracorporeal perfusion. This pilot study intended to measure the physiologic ventilatory response in patients with severe lung failure treated with ECMO and NAVA. We hypothesized that the combination of both methods could automatically provide a protective ventilation with optimized blood gases. METHODS: We report a case series of six patients treated with ECMO for severe lung failure. In the recovery phase of the disease, patients were ventilated with NAVA and ventilatory response and gas exchange parameters were measured under different sweep gas flows and temporarily inactivated ECMO. RESULTS: Tidal volumes on ECMO ranged between 2 and 5 ml/kg predicted body weight and increased up to 8 ml/kg with inactivated ECMO. Peak inspiratory pressure reached 19-29 cmH(2)O with active, and 21-45 cmH(2)O with inactivated ECMO. Ventilatory response to decreased sweep gas flow was rapid, and patients immediately regulated PaCO(2) tightly towards a physiological pH value. Increase in minute ventilation was a result of increased breathing frequency and tidal volumes, and protective ventilation was only abandoned if pH control was not achieved. CONCLUSIONS: With NAVA ventilatory response to decreased ECMO sweep gas flow was rapid, and patients immediately regulated PaCO(2) tightly towards a physiological pH value. Therefore, combination of NAVA and ECMO may permit a closed-loop ventilation with automated protective ventilation.
PURPOSE: Extracorporeal membrane oxygenation (ECMO) can support oxygenation and carbon dioxide elimination in severe lung failure. Usually it is accompanied by controlled mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is a new mode of ventilation triggered by the diaphragmatic electrical activity and controlled by the patient's respiratory centre, which may allow a close interaction between ventilation and extracorporeal perfusion. This pilot study intended to measure the physiologic ventilatory response in patients with severe lung failure treated with ECMO and NAVA. We hypothesized that the combination of both methods could automatically provide a protective ventilation with optimized blood gases. METHODS: We report a case series of six patients treated with ECMO for severe lung failure. In the recovery phase of the disease, patients were ventilated with NAVA and ventilatory response and gas exchange parameters were measured under different sweep gas flows and temporarily inactivated ECMO. RESULTS: Tidal volumes on ECMO ranged between 2 and 5 ml/kg predicted body weight and increased up to 8 ml/kg with inactivated ECMO. Peak inspiratory pressure reached 19-29 cmH(2)O with active, and 21-45 cmH(2)O with inactivated ECMO. Ventilatory response to decreased sweep gas flow was rapid, and patients immediately regulated PaCO(2) tightly towards a physiological pH value. Increase in minute ventilation was a result of increased breathing frequency and tidal volumes, and protective ventilation was only abandoned if pH control was not achieved. CONCLUSIONS: With NAVA ventilatory response to decreased ECMO sweep gas flow was rapid, and patients immediately regulated PaCO(2) tightly towards a physiological pH value. Therefore, combination of NAVA and ECMO may permit a closed-loop ventilation with automated protective ventilation.
Authors: Christer Sinderby; Jennifer Beck; Jadranka Spahija; Michel de Marchie; Jacques Lacroix; Paolo Navalesi; Arthur S Slutsky Journal: Chest Date: 2007-03 Impact factor: 9.410
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: A Esteban; F Frutos; M J Tobin; I Alía; J F Solsona; I Valverdú; R Fernández; M A de la Cal; S Benito; R Tomás Journal: N Engl J Med Date: 1995-02-09 Impact factor: 91.245
Authors: Gordon D Rubenfeld; Ellen Caldwell; Eve Peabody; Jim Weaver; Diane P Martin; Margaret Neff; Eric J Stern; Leonard D Hudson Journal: N Engl J Med Date: 2005-10-20 Impact factor: 91.245
Authors: Daniel Tuchscherer; Werner J Z'graggen; Christina Passath; Jukka Takala; Christer Sinderby; Lukas Brander Journal: Intensive Care Med Date: 2011-11-03 Impact factor: 17.440
Authors: Gianmaria Cammarota; Carlo Olivieri; Roberta Costa; Rosanna Vaschetto; Davide Colombo; Emilia Turucz; Federico Longhini; Francesco Della Corte; Giorgio Conti; Paolo Navalesi Journal: Intensive Care Med Date: 2011-10-18 Impact factor: 17.440
Authors: Eddy Fan; Luciano Gattinoni; Alain Combes; Matthieu Schmidt; Giles Peek; Dan Brodie; Thomas Muller; Andrea Morelli; V Marco Ranieri; Antonio Pesenti; Laurent Brochard; Carol Hodgson; Cecile Van Kiersbilck; Antoine Roch; Michael Quintel; Laurent Papazian Journal: Intensive Care Med Date: 2016-03-23 Impact factor: 17.440