title: Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure.
abstract: OBJECTIVE
  To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  A tertiary pediatric referral center.
  
  
  METHODS
  Children aged 1 month to 18 yrs treated with ECLS for acute respiratory failure at University of Michigan Hospitals from November 1982 to June 1993. All patients aged 1 month to 18 yrs who received ECLS for acute respiratory failure were included. Patients who received ECLS primarily for cardiac support or who had a diagnosis of congenital gastrointestinal malformation (i.e. congenital diaphragmatic hernia) were excluded.
  
  
  METHODS
  ECLS for severe pediatric respiratory failure.
  
  
  RESULTS
  Forty-nine children were treated at our center with ECLS for acute respiratory failure 36 (73%) survived. Ventilator settings immediately after decannulation from ECLS for survivors were as follows: FIO2 0.53 +/- 0.18 (SD); intermittent mandatory ventilation (IMV) 29.6 +/- 1.18 breaths/min, positive end-expiratory pressure 5.3 +/- 1.6 cm H2O, mean airway pressure 12.6 +/- 2.9 cm H2O, and peak inspiratory pressure 31.7 +/- 5.5 cm H2O. Arterial blood gas measurements at decannulation were PaO2 89.4 +/- 30.9 torr (11.9 +/- 4.1 kPa), PaCO2 43.7 +/- 9.7 torr (5.8 +/- 1.3 kPa), and pH 7.39 +/- 0.07. Twenty-four hours after decannulation, ventilator settings and arterial blood gas measurements were as follows: FIO2 0.42 +/- 0.14, IMV 27.4 +/- 13.5 breaths/min, positive end-expiratory pressure 5.2 +/- 1.6 cm H2O, mean airway pressure 12.0 +/- 3.4 cm H2O, peak inspiratory pressure 31.1 +/- 6.5 cm H2O, PaO2 77.0 +/- 16.9 torr (10.3 +/- 2.3 kPa), PaCO2 44.9 +/- 8.4 torr (6.0 +/- 1.1 kPa), and pH 7.40 +/- 0.07. Variables associated with oxygenation status (P[A-a]O2) and mean airway pressure (oxygenation index) improved during the immediate 24-hr period postbypass (p < .05).
  
  
  CONCLUSIONS
  Successful decannulation from ECLS for > 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechanical ventilation pressures for the postbypass recovering lung.
authors.affiliation: Section of Critical Care Medicine, University of Michigan Hospitals, Ann Arbor 48109-0243, USA.
authors.forename: F W
authors.initials: FW
authors.lastname: Moler
authors.forename: J M
authors.initials: JM
authors.lastname: Palmisano
authors.forename: J R
authors.initials: JR
authors.lastname: Custer
authors.forename: R H
authors.initials: RH
authors.lastname: Bartlett
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002245:Carbon Dioxide / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D010100:Oxygen / Q000097:blood*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000097:blood / Q000401:mortality / Q000628:therapy*; D017741:Survivors; D013997:Time Factors; D015300:Ventilator Weaning
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen