Egyptian Journal of Critical Care Medicine最新文献_第3页

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Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.016

Marlice van Dyk

{"title":"ECCO2R case study","authors":"Marlice van Dyk","doi":"10.1016/j.ejccm.2018.12.016","DOIUrl":"10.1016/j.ejccm.2018.12.016","url":null,"abstract":"<div><p>Hypercapnic respiratory failure is common in ICU due to ARDS and COPD exacerbations. The use of ECCO2R has changed the way we manage these patients. We report a patient with COPD exacerbation that failed NIV and placed on low flow ECCO2R. Low flow ECCO2R does not support oxygenation and only clears a proportion of the CO2 produced.</p><p>Presentation of the case: a 64 y old women with severe COPD who failed NIV was placed on ECCO2R with the Hemolung system. The severe respiratory acidosis cleared and intubation was avoided. After a few days, she became more hypoxic, and the decision was made not to intubate this patient.</p><p>There is increased CO<sub>2</sub> production and decreased clearance of CO<sub>2</sub> during COPD exacerbation. ECCO<sub>2</sub>R has been shown to improve mortality and decrease the need for intubation. There are various ECCO<sub>2</sub>R systems on the market with different flows and differently sized oxygenators.</p><p>The use of ECCO<sub>2</sub>R in selected patients is a promising add-on to conventional management of these patients. The difficulty in predicting the progression of the disease will always be a challenge. Extracorporeal therapies should be performed in centres that are experienced in the management of these patients.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126356323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run 146天体外膜氧合(ECMO):我们最长的ECMO运行时间

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.015

Ahmad Said Abdalmohsen Ali, Mohamed Yosri, Mohamed Abouelwafa, Mahmoud Saad, Kareem Zaki, Shady Mashhour, Husam Salah, Tarek Mohsen, Amaany Abozeid, Mohamed Khaled, Akram Abdelbary, Alia Abdelfattah

{"title":"One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run","authors":"Ahmad Said Abdalmohsen Ali, Mohamed Yosri, Mohamed Abouelwafa, Mahmoud Saad, Kareem Zaki, Shady Mashhour, Husam Salah, Tarek Mohsen, Amaany Abozeid, Mohamed Khaled, Akram Abdelbary, Alia Abdelfattah","doi":"10.1016/j.ejccm.2018.12.015","DOIUrl":"10.1016/j.ejccm.2018.12.015","url":null,"abstract":"<div><h3>Introduction</h3><p>Veno-venous extracorporeal membrane oxygenation (VV-ECMO) provides the respiratory support in acute severe respiratory failure until the underlying acute lung pathology improves. VV-ECMO support for.</p></div><div><h3>Aim of the work</h3><p>We describe our experience in the management of the longest ECMO run in our center.</p></div><div><h3>Methods</h3><p>A 17 years old Male patient who had only vague past medical history of recurrent abdominal pain for 5 years. Patient was admitted with severe ARDS that failed to improve with conventional ventilation, Murray Lung Injury Score was 3.5, RESP score was 1, underwent Veno-venous (V-V) ECMO via femoro-atrial approach using Maquet Cardio help console. The ECMO run duration was 146 days. Patient suffered from several complications during the ECMO run such as pulmonary hemorrhage, Acute cor pulmonale, thrombocytopenia and convulsions.</p></div><div><h3>Results</h3><p>Patient expired on ECMO day 146 with refractory septic shock even after shifting to VAV ECMO support.</p></div><div><h3>Conclusion</h3><p>Prolonged ECMO therapy poses its unique challenges. Multidisciplinary team management plays fundamental role during management of prolonged ECMO therapy.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125253021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Fresh frozen plasma: A solution to heparin resistance during extracorporeal membrane oxygenation (ECMO) 新鲜冷冻血浆:体外膜氧合(ECMO)过程中肝素耐药性的解决方案

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.020

Fayaz Mohammed Khazi , Ashraf Mahmoud Elhoufi , Tarek Ahmed AbdelAziz , Nayyer R Siddiqui , Bassil Al-Zamkan , Suresh Babu Robert , Pradeep Kumar Pillai , Obaid Aljassim

{"title":"Fresh frozen plasma: A solution to heparin resistance during extracorporeal membrane oxygenation (ECMO)","authors":"Fayaz Mohammed Khazi , Ashraf Mahmoud Elhoufi , Tarek Ahmed AbdelAziz , Nayyer R Siddiqui , Bassil Al-Zamkan , Suresh Babu Robert , Pradeep Kumar Pillai , Obaid Aljassim","doi":"10.1016/j.ejccm.2018.12.020","DOIUrl":"10.1016/j.ejccm.2018.12.020","url":null,"abstract":"<div><h3>Objective</h3><p>The management of Heparin resistance in patients undergoing ECMO is still uncertain. We sought to assess the efficacy and safety of Fresh frozen plasma to optimize the anticoagulation in these patients.</p></div><div><h3>Methods</h3><p>We studied 42 adults undergoing VA-ECMO. Heparin infusion was increased incrementally to achieve target ACT in HG group and plasma administered in FFPG group in heparin resistance (HR) patients. Statistical comparison was performed between these two groups and results compared with non-heparin resistance (Non-HR) patients.</p></div><div><h3>Results</h3><p>Overall 36% survived and 64% suffered bleeding complications. There was no difference in age (p = 0.118) or average ECMO duration (p = 0.393). The heparin requirement was significantly less in FFPG (p = 0.008) and average ACT difference of 159.2 (20.3) was highly significant (p < 0.001). Clinically the survival was higher in FFPG (50% vs 10%) without statistical difference (p = 0.07) probably due to small sample size. Twenty HR compared to 22 Non-HR patients. The survival rate (41% vs 30%) was not statistically significant (p = 0.340). However, more bleeding 80% vs 50% recorded in HR (p = 0.043) even though heparin doses between them was not different.</p></div><div><h3>Conclusions</h3><p>The heparin requirement was high in patients treated with heparin alone. Fresh frozen plasma effectively increased ACT to therapeutic target in HR patients. There was no difference in the heparin dose, significantly higher bleeding complications were recorded in HR patients. Clinically, survival was better in Non-heparin resistance and plasma treated patients that was not found to be statistically significant.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126658152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

The ECMO specialist’s role in troubleshooting ECMO emergencies ECMO专家在排除ECMO紧急情况中的作用

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.011

Arzak Hamed , Guillaume Alinier , Ibrahim Fawzy Hassan

{"title":"The ECMO specialist’s role in troubleshooting ECMO emergencies","authors":"Arzak Hamed , Guillaume Alinier , Ibrahim Fawzy Hassan","doi":"10.1016/j.ejccm.2018.12.011","DOIUrl":"10.1016/j.ejccm.2018.12.011","url":null,"abstract":"<div><p>Whether a patient still has native lung function or not, respiratory extracorporeal membrane oxygenation (ECMO) complications need an immediate response from the ECMO team assigned to the patient. Methodological troubleshooting can be a key aspect to responding to an ECMO emergency if the cause of the issue is not clearly identifiable. To decrease the incidence of ECMO emergencies clear procedures must be in place and the ECMO team must be continuously trained through a variety of approaches before attempting to put a patient on ECMO or being given the responsibility of looking after such patient. Procedures that meet Extracorporeal Life Support Organization (ELSO) standards, a sufficient level of ECMO activity, and adequate competency of the clinicians are key to the success of an ECMO program. Both procedures and clinicians can be informed and tested using didactic sessions, focus group discussions, scenario-based simulations, water drills, bedside education, and case debriefings. Such activities should be ongoing and with adequate support for monitoring of skills validation, commonly faced issues, and patient outcomes.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129241920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Anticoagulation and monitoring in pediatric extracorporeal membrane oxygenation 儿童体外膜氧合的抗凝和监测

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.014

Jamie Weller, Lakshmi Raman, Ali McMichael

引用次数: 1

Physiotherapy for ECMO patients ECMO患者的物理治疗

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.013

Marlice van Dyk

引用次数: 1

Comparison of ECMO run between H1N1 acute respiratory failure vs. non H1N1 acute respiratory failure 甲流急性呼吸衰竭与非甲流急性呼吸衰竭ECMO运行比较

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.019

Venkat Goyal , Pranay Oza , Pranali Shukla , Aditi Goyal

{"title":"Comparison of ECMO run between H1N1 acute respiratory failure vs. non H1N1 acute respiratory failure","authors":"Venkat Goyal , Pranay Oza , Pranali Shukla , Aditi Goyal","doi":"10.1016/j.ejccm.2018.12.019","DOIUrl":"10.1016/j.ejccm.2018.12.019","url":null,"abstract":"<div><p>First case of adult ECMO was reported in 1971 however after that ECMO was hardly been used in adult till 2009. The real boost to ECMO in adult respiratory failure came after 2009 mainly contributed to successful Cesar trial & an outbreak of H1N1. There are ample of papers published on H1N1 & ECMO but hardly a few papers on ECMO in non H1N1 respiratory failure. However the incidence of acute respiratory failure secondary to other tropical infections like Malaria, dengue, leptospirosis, bacterial & viral pneumonia are much higher in India & Asian countries. ECMO is underutilized for these tropical infections especially in India mainly due to financial constraints but also because of lack of awareness & lack of published data to support. We thought of publishing our own data on role of ECMO and outcome in H1N1 & non H1N1 respiratory failure.</p></div><div><h3>Methods</h3><p>It is a Retrospective analysis of data collected of patients with acute respiratory failure managed on ECMO from January 2010 to November 2018.</p></div><div><h3>Results</h3><p>The total 169 patients of respiratory failure were treated with ECMO during specified period. Out of this 169, 81 patients had H1N1 infection & remaining 88 were some other cause of respiratory failure all categorized under Non H1N1 group.</p><p>There was not much difference in the survival in both the groups but ECMO runs remain significantly short (9.5 vs. 18.78 days) in non H1N1 group. Long run ECMO more than 30 days is seen in H1N1 with good survival (71.42%).</p></div><div><h3>Conclusions</h3><p>ECMO is equally effective in Non H1N1 & H1N1 respiratory failure with much shorter ECMO run in Non H1N1 respiratory failure. Survival with ECMO in tropical infections like Malaria, Dengue & Leptospirosis is more than 60%.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124750363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of coagulopathy on veno-arterial ECMO (VA) extracorporeal membrane oxygenation using platelet aggregometry and standard tests: A narrative review 应用血小板聚集和标准试验评价静脉-动脉ECMO (VA)体外膜氧合的凝血功能:一个叙述回顾

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.021

Poonam Malhotra Kapoor, Ameya Karanjkar, Vandana Bhardwaj

{"title":"Evaluation of coagulopathy on veno-arterial ECMO (VA) extracorporeal membrane oxygenation using platelet aggregometry and standard tests: A narrative review","authors":"Poonam Malhotra Kapoor, Ameya Karanjkar, Vandana Bhardwaj","doi":"10.1016/j.ejccm.2018.12.021","DOIUrl":"10.1016/j.ejccm.2018.12.021","url":null,"abstract":"<div><p>Extracorporeal membrane oxygenation (ECMO) is an established therapy for patients with cardiac failure, pulmonary failure or cardiopulmonary failure. To suppress the activation of the coagulation cascade, anticoagulation is necessary. Unfractionated heparin (UFH) is typically used for achieving the levels of therapeutic anticoagulation (ACT 180-220). Recently, viscoelastic tests of coagulation such as thrombo-elastrographyc (TEG) and ROTEM are increasingly used as they have shorter turnaround time and provide sensitive information about composition of clot, clot strength which can be used to assess and treat the coagulopathy on ECMO patients. POC coagulation management with ROTEM and impedance aggregometry is now frequently used to determine first-line therapy with specific coagulation factor concentrates such as fibrinogen concentrates and prothrombin complex concentrates.</p><p>Extracorporeal circuit of ECMO causes both quantitative and qualitative dysfunction of platelets due to activation and consumption. All studies so far has indicated reduced platelet aggregation in adult patients during ECMO. There is a strong association between platelet count and platelet aggregation. A consumptive platelet state due to platelet adhering to the ECMO circuit will all cause an increased tendency of patients bleeding ECMO. This narrative literature review brings to light some literature points on the role of platelet aggregometry during ECMO. ECMO is a form of cardiopulmonary bypass if platelet aggregation is reduced in ECMO, then this could play a role for the development therapies, which would inhibit platelets and prevent coagulation activation within the ECMO circuit, thus reducing bleeding in ECMO improving mortality.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126526181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Case report: Septic shock, addressing aspects of the organism and the resultant effects on the vasculature 病例报告:感染性休克，处理有机体的各个方面和由此产生的对脉管系统的影响

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.012

Gerasimos Capatos

引用次数: 0

ECMO is in the air: Long distance air/ground transport of a child on extra corporeal membrane oxygenation 体外膜氧合:在体外膜氧合下对儿童进行长距离空中/地面输送

IF 0.3

Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI: 10.1016/j.ejccm.2018.12.010

Jana Assy , Ibrahim Fawzi , Mariam Arabi , Ziad Bulbul , Fadi Bitar , Mariane Majdalani , Rana Sharara , Issam El Rassi

{"title":"ECMO is in the air: Long distance air/ground transport of a child on extra corporeal membrane oxygenation","authors":"Jana Assy , Ibrahim Fawzi , Mariam Arabi , Ziad Bulbul , Fadi Bitar , Mariane Majdalani , Rana Sharara , Issam El Rassi","doi":"10.1016/j.ejccm.2018.12.010","DOIUrl":"10.1016/j.ejccm.2018.12.010","url":null,"abstract":"<div><h3>Background</h3><p>Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical support system that handles the function of the heart and/or lungs in patients with a variety of cardiac and respiratory problems. Veno-arterial ECMO is most commonly used for patients recovering from heart surgery, suffering from cardiac shock, or awaiting a heart transplant.</p></div><div><h3>Case report</h3><p>A 7 year old boy with a single ventricle physiology was admitted for a Fontan procedure with repair of the common valve. At the end of surgery, transesophagal echocardiography showed a severely depressed myocardial function, and weaning of bypass required a high inotropic support. During the following week, the heart never recovered, with an ejection fraction at 24%. Veno-Arterial ECMO was decided on postoperative day 9 with a 19 Fr venous cannula inserted through the right jugular vein into the intracardiac Fontan baffle, and a 15 Fr arterial cannula into the right carotid artery.</p><p>On ECMO day 7, after failure to wean from ECMO, he was listed for an urgent heart transplant, with the suggestion of a transfer to Europe, for a shorter transplantation delay.</p><p>The ECMO team from Hamad Hospital in Qatar accomplished the transfer successfully, on a humanitarian basis. The transfer was done on ECMO Day 10. The child was safely admitted to a hospital in Belgium, and listed again for an urgent heart transplant.</p></div><div><h3>Conclusion</h3><p>With an experienced team, and the proper equipment, on-ECMO air transport of critical patients over thousands of kilometers is today safely feasible.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129057638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1