Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure.
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.
Moler
F W
FW
Section of Critical Care Medicine, University of Michigan Hospitals, Ann Arbor 48109-0243, USA.
Palmisano
J M
JM
Custer
J R
JR
Bartlett
R H
RH
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
D002245:Carbon Dioxide; D010100:Oxygen