Giuseppe
Emeritus
[Source: The New England Journal of Medicine, full text: (LINK). Extract, edited.]
Extracorporeal Membrane Oxygenation for ARDS in Adults
Daniel Brodie, M.D., and Matthew Bacchetta, M.D.
N Engl J Med 2011; 365:1905-1914 November 17, 2011
This article has no abstract; the first 100 words appear below.
Foreword
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations.
Stage
A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy. She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (PaO<SUB>2</SUB>) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO<SUB>2</SUB>) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular (. . .)
Dr. Brodie reports receiving consulting fees and travel expenses from Maquet Cardiovascular, being a member of its cardiovascular advisory board, and anticipating possible receipt of grant support from Maquet Cardiovascular. Dr. Bacchetta reports receiving consulting fees and travel expenses from Maquet Cardiovascular, anticipating possible receipt of grant support from Maquet Cardiovascular, and discussing with Avalon Laboratories a possible instructional video for which he would not be paid.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No other potential conflict of interest relevant to the article was reported.
This article (10.1056/NEJMct1103720) was updated on November 17, 2011, at NEJM.org.
We thank Dr. Roy G. Brower of Johns Hopkins University for his invaluable help and advice; Drs. Robert C. Basner, Kristin M. Burkart, and Neil W. Schluger of the Columbia College of Physicians and Surgeons for their thoughtful review and suggestions; James R. Beck and Linda B. Mongero of New York?Presbyterian Hospital for their expertise; and Lara Durrant and Peter Kuempel of Columbia University for their outstanding work on an earlier draft of the figures.
Source Information
From Columbia University College of Physicians and Surgeons, and New York?Presbyterian Hospital ? both in New York. Address reprint requests to Dr. Brodie at the Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 630 W. 168th St., PH 8 East, New York, NY 10032, or at hdb5@columbia.edu.
- ------Daniel Brodie, M.D., and Matthew Bacchetta, M.D.
N Engl J Med 2011; 365:1905-1914 November 17, 2011
This article has no abstract; the first 100 words appear below.
Foreword
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations.
Stage
A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy. She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (PaO<SUB>2</SUB>) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO<SUB>2</SUB>) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular (. . .)
Dr. Brodie reports receiving consulting fees and travel expenses from Maquet Cardiovascular, being a member of its cardiovascular advisory board, and anticipating possible receipt of grant support from Maquet Cardiovascular. Dr. Bacchetta reports receiving consulting fees and travel expenses from Maquet Cardiovascular, anticipating possible receipt of grant support from Maquet Cardiovascular, and discussing with Avalon Laboratories a possible instructional video for which he would not be paid.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No other potential conflict of interest relevant to the article was reported.
This article (10.1056/NEJMct1103720) was updated on November 17, 2011, at NEJM.org.
We thank Dr. Roy G. Brower of Johns Hopkins University for his invaluable help and advice; Drs. Robert C. Basner, Kristin M. Burkart, and Neil W. Schluger of the Columbia College of Physicians and Surgeons for their thoughtful review and suggestions; James R. Beck and Linda B. Mongero of New York?Presbyterian Hospital for their expertise; and Lara Durrant and Peter Kuempel of Columbia University for their outstanding work on an earlier draft of the figures.
Source Information
From Columbia University College of Physicians and Surgeons, and New York?Presbyterian Hospital ? both in New York. Address reprint requests to Dr. Brodie at the Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 630 W. 168th St., PH 8 East, New York, NY 10032, or at hdb5@columbia.edu.