title: Extracorporeal membrane oxygenation in 5 patients with bronchial fistula with severe acute lung injury.
abstract: OBJECTIVE
  The management of bronchial fistula associated with acute lung injury raises two major concerns: (1) high ventilation pressures are necessary for lung recruitment but detrimental for fistula healing, and (2) adequate lung recruitment is prevented by large air leak. Primary surgical closure of bronchial fistula should be attempted but is rarely successful during mechanical ventilation. We sought to evaluate the efficacy of extracorporeal membrane oxygenation associated with lung-protective ventilation in case of failure of conventional management.
  
  
  METHODS
  Arteriovenous extracorporeal membrane oxygenation was initiated by femorofemoral cannulation. A stepwise increase of extracorporeal membrane oxygenation output and a decrease of mechanical ventilation settings were simultaneously performed, aiming at lung-protective ventilation.
  
  
  RESULTS
  During a 1-year period, this protocol management was used in 5 patients with refractory respiratory failure associated with bronchial fistula after thoracic operations. This strategy allowed fistula healing in 3 patients.
  
  
  CONCLUSIONS
  If correctly timed, extracorporeal membrane oxygenation can provide a therapeutic bridge to lung-protective ventilation and allow bronchial fistula healing in case of refractory respiratory failure.
authors: Department of Anesthesiology and Surgical Intensive Care Unit, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris, Paris, France.
authors: Omar
authors: O
authors: Daoud
authors: Pascal
authors: P
authors: Augustin
authors: Pierre
authors: P
authors: Mordant
authors: Sigismond
authors: S
authors: Lasocki
authors: Nawwar
authors: N
authors: Al-Attar
authors: Jean-Michel
authors: JM
authors: Maury
authors: Mathieu
authors: M
authors: Desmard
authors: Dan
authors: D
authors: Longrois
authors: Philippe
authors: P
authors: Montravers
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001983:Bronchial Fistula / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012494:Sampling Studies; D015996:Survival Rate; D016896:Treatment Outcome