SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) is a therapy for refractory hypoxemia due to Acute Respiratory Distress Syndrome (ARDS). Previous studies of ARDS patients not treated with VV ECMO described radiographic changes post ARDS which showed reticular CT changes mostly in anterior distribution.1 A longitudinal study of patients five years post ARDS showed near normal pulmonary function tests (PFTs).2 Little is known about the radiographic and functional pulmonary recovery of the most severe subgroup of ARDS patients who required ECMO.
METHODS: This is a single center descriptive study to evaluate radiographic changes and PFTs in post ARDS patients treated with VV ECMO. Three female and two male adults with ARDS, averaging 46.4 ± 7 years were included. There were two cases due to Influenza A H1N1, two due to community acquired pneumonia, and one of unknown etiology. All presented with severe, persistent hypoxia with a PF ratio <100 requiring VV ECMO.
RESULTS: The average time on VV ECMO was 35.25 days (range 12-71 days) and the average hospital stay was 72.75 days (range 33-154 days). All patients required tracheostomy and were discharged to a long-term acute care hospital where they were weaned off of mechanical ventilation. Initial chest CT scans showed bilateral parenchymal consolidations, ground glass opacities, air trapping, and in one case spontaneous pneumothorax. Chest CT follow up averaged 168 days post ECMO; while significant improvement was seen in consolidations and ground glass opacities, there remained abnormal persistent interstitial opacities. PFT follow up averaged 176 days post ECMO for four patients, one patient did not have follow up PFTs. The PFTs showed significantly decreased TLC (averaging 68% ± 11% predicted), DLCO (averaging 36% ± 8% predicted), and FEV1 (averaging 64% ± 14% predicted).
CONCLUSIONS: In this descriptive study, patients without previous pulmonary disease who presented with severe ARDS requiring VV ECMO, had significant residual pulmonary abnormalities on PFT’s including decreased DLCO, TLC, and FEV1 and persistent chest CT abnormalities including interstitial opacities. Further research is needed to evaluate long-term recovery in post ARDS VV ECMO patients.
CLINICAL IMPLICATIONS: Patients with severe ARDS post V-V ECMO had significant residual defects on follow up PFT and chest CT scans.
DISCLOSURE: The following authors have nothing to disclose: Matthew Miles, Dorothea Watson, Rita Pechulis
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