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Zhongguo Wei Zhong Bing Ji Jiu Yi Xue · Mar 2010
[The lung protection strategy under the support of extracorporeal membrane oxygenation in patients suffering from influenza A H1N1].
- Lei Xu, Zhong-zhen Du, Xin-jing Gao, Ying-zhi Qin, and Zhi-bo Li.
- Department of Critical Care Medicine, the Third Central Hospital of Tianjin, Tianjin 300170, China.
- Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010 Mar 1;22(3):150-2.
ObjectiveTo study the effect of extracorporeal membrane oxygenation (ECMO) in patients suffering from severe pneumonia complicating influenza A H1N1 by putting lungs in rest to protect the latter.MethodsFive patients with severe pneumonia following influenza A H1N1 were treated with ECMO and different modes of mechanical ventilation at the same time. Two patients died, both of them received synchronized intermittent mandatory ventilation (SIMV) and bi-level positive airway pressure (BiPAP) modes, with airway pressure release ventilation (APRV) to control lung expansion with expansion pressure 40 cm H(2)O (1 cm H(2)O=0.098 kPa). In 3 survivors, the strategy of lung rest was performed by giving an optimized positive end expiratory pressure (PEEP) with an optimal compliance by gradually elevation of PEEP, and high-level pressure (Phigh) at 20 cm H(2)O by application of BiPAP mode.ResultsOne patient died due to lung damage and repeated spontaneous pneumothorax and sepsis; 1 patient died due to multiple organ dysfunction syndrome. Three patients recovered after following the strategy of lung rest.ConclusionWhen ECMO is used for severe pneumonia complicating influenza A H1N1, prognosis can be obviously improved, with decrease in the occurrence of lung damage through the protection strategy of lung rest.
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