ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To assess whether partitioning the elastance of the respiratory system (E RS) between lung (E L) and chest wall (E CW) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLATL) close to its upper physiological limit (25 cmH2O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009–January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLATL (25 cmH2O).
Fourteen patients were referred for ECMO. In seven patients PPLATL was 27.2 ± 1.2 cmH2O; all these patients underwent ECMO. In the other seven patients, PPLATL was 16.6 ± 2.9 cmH2O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH2O, P = 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLATL = 25.3 ± 1.7 cm H2O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4, P = 0.0001) allowing patients to be treated with conventional ventilation.
Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLATRS). In these patients, titrating PEEP to PPLATRS may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO.
- ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure
Intensive Care Medicine
Volume 38, Issue 3 , pp 395-403
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Influenza A (H1N1)
- Transpulmonary pressure
- Extracorporeal membrane oxygenation
- Industry Sectors
- Author Affiliations
- 1. Dipartimento dell’Emergenza e Trapianti d’Organo, Sezione di Anestesiologia e Rianimazione, Università degli Studi Aldo Moro, Bari, Italy
- 2. Dipartimento di Anestesia e di Medicina degli Stati Critici, Ospedale S.Giovanni Battista-Molinette Università di Torino, Corso Dogliotti 14, 10126, Turin, Italy
- 3. Dipartimento di Medicina Sperimentale, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
- 4. Dipartimento di Anestesia Cardiaca e Terapia Intensiva, Università Vita-Salute San Raffaele, Milan, Italy
- 5. Dipartimento di Anestesiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico – Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy