title: The influence of lung injury due to mechanical ventilation on the initiation of ECMO.
abstract: Before the entry criteria for extracorporeal membrane oxygenation (ECMO) are met, newborns may require aggressive mechanical ventilation which may result in lung injury. The question arises whether the presence of a pneumothorax in these infants plays a role in the prognosis. Of the 21 newborns transferred to our hospital for ECMO, 8 were treated with ECMO. 9 of the 21 newborns developed a pneumothorax with conventional ventilation and 6 of these 9 newborns subsequently required ECMO. Infants who developed a pneumothorax but did not meet ECMO criteria and remained in the oxygenation index (OI) range between 25 and 40 for more than 2 days had a poorer prognosis. If adequate oxygenation cannot be attained with acceptable mechanical ventilation and a more aggressive ventilation results in a pneumothorax, ECMO should be considered even if the oxygenation index is below 40.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, Benjamin Franklin University Hospital, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bartsch
authors.forename: H
authors.initials: H
authors.lastname: Kössel
authors.forename: G
authors.initials: G
authors.lastname: Brummer
authors.forename: W
authors.initials: W
authors.lastname: Philippi
authors.forename: J
authors.initials: J
authors.lastname: Waldschmidt
authors.forename: K
authors.initials: K
authors.lastname: Eyrich
authors.forename: H
authors.initials: H
authors.lastname: Versmold
mesh_terms: D001784:Blood Gas Analysis; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology*; D011030:Pneumothorax / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate