Alberto Lucchini1, Christian De Felippis2, Giulia Pelucchi3, Giacomo Grasselli4, Nicolò Patroniti3, Luigi Castagna4, Giuseppe Foti3, Antonio Pesenti4, Roberto Fumagalli5. 1. General Intensive Care Unit, Emergency Department - San Gerardo Hospital, University of Milan-Bicocca, Via Pergolesi 33, Monza (MB), Italy; University of Milan-Bicocca, Milan, Italy. Electronic address: alberto.lucchini@unimib.it. 2. Adult Intensive Care Unit, Glenfield Hospital, University Hospital of Leicester-NHS Trust, Groby Rd, Leicester LE3 9QP, United Kingdom. 3. General Intensive Care Unit, Emergency Department - San Gerardo Hospital, University of Milan-Bicocca, Via Pergolesi 33, Monza (MB), Italy. 4. General Intensive Care Unit - Department of Anesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, MI, Italy. 5. University of Milan-Bicocca, Milan, Italy; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital, Milan, Italy.
Abstract
INTRODUCTION: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. OBJECTIVE: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. METHODS: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. RESULTS: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 hours (IQR 6-10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82-135), 152 (93-185), 149 (90-186) and 113 (74-182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. CONCLUSIONS: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.
INTRODUCTION: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. OBJECTIVE: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. METHODS: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. RESULTS: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 hours (IQR 6-10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82-135), 152 (93-185), 149 (90-186) and 113 (74-182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. CONCLUSIONS: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.
Authors: Jonathan Rilinger; Viviane Zotzmann; Xavier Bemtgen; Carin Schumacher; Paul M Biever; Daniel Duerschmied; Klaus Kaier; Peter Stachon; Constantin von Zur Mühlen; Manfred Zehender; Christoph Bode; Dawid L Staudacher; Tobias Wengenmayer Journal: Crit Care Date: 2020-07-08 Impact factor: 9.097