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Postoperative Management of Respiratory Failure: Extracorporeal Ventilatory Therapy

  • Vera von DossowEmail author
  • Maria Deja
  • Bernhard Zwissler
  • Claudia Spies
Chapter

Abstract

Post-thoracotomy acute lung injury is one of the leading causes of mortality after thoracic surgery. Several trigger factors have been identified such as preoperative conditions, surgery-associated inflammation, fluid overload, ventilator-induced lung injury, one-lung ventilation, as well as transfusions. In severe cases the clinical presentation is an acute respiratory distress syndrome in adult patients with a high mortality rate. In the last decade, the concept of lung-“protective” ventilation strategies has been gaining importance in thoracic surgery.

However, in a case of severe post-thoracotomy acute lung injury refractory to maximal conservative treatment, the use of extracorporeal ventilatory therapy might be indicated representing the concept of “lung rest.”

Keywords

Postoperative acute lung injury (PALI) Acute respiratory distress syndrome (ARDS) Lung-protective ventilation strategies Extracorporeal membrane oxygenation (ECMO) 

Abbreviations

ACT

Activated clotting time

aPTT

Activated partial thromboplastin time

ARDS

Acute respiratory distress syndrome

BIPAP

Bi-level positive airway pressure

CO

Cardiac output

CO2

Carbon dioxide

CPAP

Continuous positive airway pressure

DLB

Double-lumen single bicaval cannula

ECCO2R

Extracorporeal carbon dioxide removal

ECMO

Extracorporeal membrane oxygenation

FIO2

Inspiratory oxygen concentration

HFOV

High-frequency oscillation ventilation

HITT

Heparin-induced thrombocytopenia

LV

Left ventricular

PALI

Post-thoracotomy acute lung injury

PBW

Predicted body weight

PEEP

Positive end-expiratory pressure

PMP

Polymethylpentene

RAS

Renin-angiotensin system

RV

Right ventricular

VA

Veno-arterial

VJI

Vena jugularis interna

VV

Veno-venous

Supplementary material

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vera von Dossow
    • 1
    • 2
    Email author
  • Maria Deja
    • 3
  • Bernhard Zwissler
    • 1
  • Claudia Spies
    • 3
  1. 1.Department of AnesthesiologyLudwig-Maximilians Universität München, Klinikum GroßhadernMunichGermany
  2. 2.Heart and Diabetes Center Bad Oeynhausen, Ruhr-University BochumBochumGermany
  3. 3.Department of Anesthesiology and Intensive Care MedicineCharité-University Medicine BerlinBerlinGermany

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