Abstract
Purpose
To describe the use of a pumpless extracorporeal lung assist device in the treatment of severe acute respiratory distress syndrome (ARDS).
Clinical features
A 15-yr-old girl developed severe post-traumatic ARDS. After all conventional treatment strategies failed, we inserted a pumpless extracorporeal lung assist device. This device consists of an arterial cannula inserted into the femoral artery, and a membrane oxygenator with a venous cannula that returns the oxygenated blood back to the patient’s femoral vein. Since the driving force is the patient’s blood pressure, a roller pump with its negative side effects is not needed. The device allowed removal of excessive PaCO2 and, by applying minimal ventilation, minimization of further ventilator-induced lung injury. The pumpless extracorporeal lung assist device remainedin situ for ten days without any adverse side effect. During this time, the lung recovered such that mechanical ventilation could be reinstalled cautiously. The device was then removed and, after a prolonged period of intensive care, the patient recovered without any sequelae.
Conclusion
In this case of a severely damaged lung, an arteriovenous pumpless extracorporeal lung assist was a helpful device to remove elevated CO2 and reduce mechanical stress by applying minimal ventilation. This device is simple to operate and has the potential of being used routinely in the treatment of severe ARDS.
Résumé
Objectif
Décrire ľusage ďun appareil ďassistance respiratoire extracorporelle sans pompe dans le traitement ďun syndrome de détresse respiratoire aiguë (SDRA) sévère.
Éléments cliniques
Un SDRA post-traumatique sévère s’est développé chez une jeune fille de 15 ans. Après ľéchec de toutes les stratégies habituelles de traitement, nous avons inséré un appareil ďassistance respiratoire extracorporelle sans pompe. Cet appareil comprend une canule artérielle insérée dans ľartère fémorale et un oxygénateur à membrane avec une canule veineuse qui retourne le sang oxygéné dans la veine fémorale du patient. Comme la force ďentraînement est la tension artérielle du patient, une pompe à rouleaux, qui présente des effets secondaires négatifs, n’est pas nécessaire. Ľappareil permet le retrait de la PaCO2 excessive et, en appliquant une ventilation minimale, la réduction ďune lésion respiratoire supplémentaire induite par la ventilation mécanique. Ľappareil est demeuré in situ pendant dix jours sans aucun effet secondaire indésirable. Pendant cette période, le poumon s’est rétabli de sorte que la ventilation mécanique a pu être réinstallée prudemment. Ľappareil a ensuite été retiré et, après une période prolongée de soins intensifs, la récupération de la patiente a été sans séquelles.
Conclusion
Dans ce cas ďatteinte respiratoire sévère, une assistance respiratoire artérioveineuse extracorporelle sans pompe a été très utile pour éliminer le CO2 élevé et réduire le stress mécanique en appliquant une ventilation minimale. Cet appareil est ďusage simple et peut être utilisé de routine dans le traitement du SDRA sévère.
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Ruettimann, U., Ummenhofer, W., Rueter, F. et al. Management of acute respiratory distress syndrome using pumpless extracorporeal lung assist. Can J Anesth 53, 101–105 (2006). https://doi.org/10.1007/BF03021536
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DOI: https://doi.org/10.1007/BF03021536