title: Reducing time on for extra-corporeal membrane oxygenation for adults with H1N1 pneumonia with the use of the Volume Diffusive Respirator.
abstract: BACKGROUND
  The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO.
  
  
  METHODS
  Adults who survived ECMO were compared regarding time on ECMO for those treated with the Volume Diffusive Respirator (VDR) or with conventional "lung rest." The VDR delivered 500 percussions/min, with tidal pressures of 24/12 cm H2O and a fraction of inspired oxygen of .4 at 15 beats/min.
  
  
  RESULTS
  There were no differences between the study patients (n = 7) and the Extracorporeal Life Support Organization cohort (n = 150) regarding age, pre-ECMO ventilator days, pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen, or survival after lung recovery. Patients treated with VDR required ECMO support for a shorter duration (mean, 193.29 ± 35.71 vs 296.63 ± 18.17 hours; P = .029).
  
  
  CONCLUSIONS
  These data suggest that the VDR enhanced pulmonary recovery from severe H1N1 pneumonia in adults. Shorter times on ECMO may improve the risk/benefit and cost/benefit ratios associated with ECMO care.
authors.affiliation: Legacy Emanuel Medical Center, Portland, OR, USA. amichael@lhs.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Hill
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Bernie P
authors.initials: BP
authors.lastname: Sperley
authors.forename: Brian P
authors.initials: BP
authors.lastname: Young
authors.forename: Paulene K
authors.initials: PK
authors.lastname: Park
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006612:High-Frequency Ventilation / Q000295:instrumentation*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000628:therapy*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical