Skip to main content
SpringerLink
Log in

Respiratory Monitoring of the ECMO Patient

  • Chapter
  • First Online:
ECMO-Extracorporeal Life Support in Adults

  • 5717 Accesses

Abstract

Venovenous extracorporeal membrane oxygenation by modifying venous blood gas content can totally or partially substitute the gas exchange functions of patient lungs, therefore respiratory monitoring always needs to take into account the extracorporeal gas exchange and the hemodynamic. Few literature data are available, therefore local experiences are critical; in our ICU, we commonly monitor patients undergoing vv-ECMO with a Swan-Ganz catheter with continuous monitoring of mixed venous blood saturation. In addition to arterial and venous blood gas data, we daily withdraw blood at the ECMO inlet and outlet to perform a global assessment of the patient. We are therefore able to distinguish the oxygenation relative to native lung and extracorporeal support, the intrapulmonary shunt, and several other parameters that allow us to assess the state of the patient’s lungs and guide us in preventing further damage to an already compromised lung parenchyma. New technologies are becoming standard practice at the bedside and are helping us in this challenging task that is also becoming increasingly difficult given the expansion of fields of application of the extracorporeal support.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kolobow T, Gattinoni L, Tomlinson TA, Pierce JE (1977) Control of breathing using an extracorporeal membrane lung. Anesthesiology 46:138–141

    Article  CAS  PubMed  Google Scholar 

  2. Gattinoni L, Pesenti A, Kolobow T, Damia G (1983) A new look at therapy of the adult respiratory distress syndrome: motionless lungs. Int Anesthesiol Clin 21:97–117

    Article  CAS  PubMed  Google Scholar 

  3. Gross R (2007) Arterial blood gas measurement. In: Parrillo J (ed) Critical care medicine, Elsevier, Philadelphia, PA, USA

    Google Scholar 

  4. ELSO guidelines. http://www.elso.med.umich.edu/Guidelines.html

  5. Bartlett RH (2012) Physiology of extracorporeal life support. In: ECMO: extracorporeal cardiopulmonary support in critical care. Extracorporeal Life Support Organization, Ann Arbor, MI, USA

    Google Scholar 

  6. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824

    Article  CAS  PubMed  Google Scholar 

  7. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533

    PubMed  Google Scholar 

  8. Luhr OR, Karlsson M, Thorsteinsson A, Rylander C, Frostell CG (2000) The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation. Intensive Care Med 26:508–517

    Article  CAS  PubMed  Google Scholar 

  9. Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet JF, Eisner MD, Matthay MA (2002) Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med 346:1281–1286

    Article  PubMed  Google Scholar 

  10. Aboab J, Louis B, Jonson B, Brochard L (2006) Relation between PaO2/FIO2 ratio and FIO2: a mathematical description. Intensive Care Med 32:1494–1497

    Article  PubMed  Google Scholar 

  11. Gowda MS, Klocke RA (1997) Variability of indices of hypoxemia in adult respiratory distress syndrome. Crit Care Med 25:41–45

    Article  CAS  PubMed  Google Scholar 

  12. Ferguson ND, Kacmarek RM, Chiche JD, Singh JM, Hallett DC, Mehta S, Stewart TE (2004) Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med 30:1111–1116

    Article  PubMed  Google Scholar 

  13. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363

    Article  PubMed  Google Scholar 

  14. Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, Iotti GA, Arcadipane A, Panarello G, Ranieri VM, Terragni P, Antonelli M, Gattinoni L, Oleari F, Pesenti A (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 37:1447–1457

    Article  PubMed  Google Scholar 

  15. Bayrakci B, Josephson C, Fackler J (2007) Oxygenation index for extracorporeal membrane oxygenation: is there predictive significance? J Artif Organs 10:6–9

    Article  PubMed  Google Scholar 

  16. Durand M, Snyder JR, Gangitano E, Wu PY (1990) Oxygenation index in patients with meconium aspiration: conventional and extracorporeal membrane oxygenation therapy. Crit Care Med 18:373–377

    Article  CAS  PubMed  Google Scholar 

  17. Covelli HD, Nessan VJ, Tuttle WK 3rd (1983) Oxygen derived variables in acute respiratory failure. Crit Care Med 11:646–649

    Article  CAS  PubMed  Google Scholar 

  18. Oliven A, Abinader E, Bursztein S (1980) Influence of varying inspired oxygen tensions on the pulmonary venous admixture (shunt) of mechanically ventilated patients. Crit Care Med 8:99–101

    Article  CAS  PubMed  Google Scholar 

  19. Rasanen J, Downs JB, Malec DJ, Oates K (1987) Oxygen tensions and oxyhemoglobin saturations in the assessment of pulmonary gas exchange. Crit Care Med 15:1058–1061

    Article  CAS  PubMed  Google Scholar 

  20. Rossaint R, Hahn SM, Pappert D, Falke KJ, Radermacher P (1995) Influence of mixed venous PO2 and inspired O2 fraction on intrapulmonary shunt in patients with severe ARDS. J Appl Physiol 78:1531–1536

    CAS  PubMed  Google Scholar 

  21. Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L (2008) Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 178:346–355

    Article  PubMed  Google Scholar 

  22. Patroniti N, Bellani G, Cortinovis B, Foti G, Maggioni E, Manfio A, Pesenti A (2010) Role of absolute lung volume to assess alveolar recruitment in acute respiratory distress syndrome patients. Crit Care Med 38:1300–1307

    PubMed  Google Scholar 

  23. Gattinoni L, Pesenti A (2005) The concept of “baby lung”. Intensive Care Med 31:776–784

    Article  PubMed  Google Scholar 

  24. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38:1573–1582

    Article  PubMed  Google Scholar 

  25. Henzler D, Pelosi P, Dembinski R, Ullmann A, Mahnken AH, Rossaint R, Kuhlen R (2005) Respiratory compliance but not gas exchange correlates with changes in lung aeration after a recruitment maneuver: an experimental study in pigs with saline lavage lung injury. Crit Care 9:R471–R482

    Article  PubMed Central  PubMed  Google Scholar 

  26. Cortes GA, Marini JJ (2013) Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume. Crit Care 17:219

    Article  PubMed Central  PubMed  Google Scholar 

  27. Grasso S, Terragni P, Birocco A, Urbino R, Del Sorbo L, Filippini C, Mascia L, Pesenti A, Zangrillo A, Gattinoni L, Ranieri VM (2012) ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med 38:395–403

    Article  CAS  PubMed  Google Scholar 

  28. The ARDS network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–1308

    Google Scholar 

  29. Bellani G, Messa C, Guerra L, Spagnolli E, Foti G, Patroniti N, Fumagalli R, Musch G, Fazio F, Pesenti A (2009) Lungs of patients with acute respiratory distress syndrome show diffuse inflammation in normally aerated regions: a [18F]-fluoro-2-deoxy-D-glucose PET/CT study. Crit Care Med 37:2216–2222

    Article  PubMed  Google Scholar 

  30. Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, Faggiano C, Quintel M, Gattinoni L, Ranieri VM (2009) Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology 111:826–835

    Article  PubMed  Google Scholar 

  31. Foti G, Cereda M, Banfi G, Pelosi P, Fumagalli R, Pesenti A (1997) End-inspiratory airway occlusion: a method to assess the pressure developed by inspiratory muscles in patients with acute lung injury undergoing pressure support. Am J Respir Crit Care Med 156:1210–1216

    Article  CAS  PubMed  Google Scholar 

  32. Mauri T, Bellani G, Grasselli G, Confalonieri A, Rona R, Patroniti N, Pesenti A (2013) Patient-ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity. Intensive Care Med 39:282–291

    Article  PubMed  Google Scholar 

  33. Bellani G, Mauri T, Coppadoro A, Grasselli G, Patroniti N, Spadaro S, Sala V, Foti G, Pesenti A (2013) Estimation of patient’s inspiratory effort from the electrical activity of the diaphragm. Crit Care Med 41(6):1483–1491

    Article  PubMed  Google Scholar 

  34. Protti A, Cressoni M, Santini A, Langer T, Mietto C, Febres D, Chierichetti M, Coppola S, Conte G, Gatti S, Leopardi O, Masson S, Lombardi L, Lazzerini M, Rampoldi E, Cadringher P, Gattinoni L (2011) Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med 183:1354–1362

    Article  PubMed  Google Scholar 

  35. Via G, Storti E, Gulati G et al (2012) Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 78:1282–1296

    Google Scholar 

  36. Via G, Lichtenstein D, Mojoli F et al (2010) Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes. Intensive Care Med 36:999–1007

    Google Scholar 

  37. Bouhemad B, Liu ZH Arbelot C et al (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84–92

    Google Scholar 

  38. Bouhemad B, Brisson H, Le-Guen M et al (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Resp Crit Care Med 183:341–347

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Scienze della Salute, Università di Milano-Bicocca, Ospedale San Gerardo Nuovo dei Tintori, Via Donizetti 106, Monza, Milan, 20900, Italy

    Alberto Zanella & Luigi Castagna

  2. SC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico S. Matteo, Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Sezione di Anestesia Rianimazione e Terapia Antalgica, Università degli Studi di Pavia, V.le Golgi 19, Pavia, 27100, Italy

    Francesco Mojoli

  3. Department of Health Sciences, Department of Urgency and Emergency, Milano-Bicocca University, San Gerardo Hospital, Via Pergolesi 33, Monza, (MB), 20900, Italy

    Nicolò Patroniti MD

Authors
  1. Alberto Zanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Mojoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicolò Patroniti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Zanella .

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza (MB), Italy

    Fabio Sangalli

  2. Department of Health Sciences Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza (MB), Italy

    Nicolò Patroniti

  3. Health Science Departement, Università Milano Bicocca Facoltà Medicina e Chirurgia, Monza (MB), Italy

    Antonio Pesenti

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Zanella, A., Mojoli, F., Castagna, L., Patroniti, N. (2014). Respiratory Monitoring of the ECMO Patient. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_21

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5427-1_21

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5426-4

  • Online ISBN: 978-88-470-5427-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation