Critical Care: Mechanical Ventilation & Respiratory Failure I |

Physiologic Benefit of Early Mechanical Ventilation Weaning of Patients on Extra Corporeal Life Support (ECLS) Therapy Secondary to Respiratory Failure FREE TO VIEW

Killol Patel, MD; Harish Seethamraju
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Newark Beth Israel Medical Center, Monroe Township, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):313A. doi:10.1016/j.chest.2016.08.326
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To demonstrate physiologic benefit to early weaning of patients from mechanical ventilation in patients on ECLS therapy secondary to respiratory failure.

METHODS: A retrospective chart review was conducted on all patients undergoing veno-venous extra-corporeal membrane oxygenation (VV ECMO) for acute hypoxic respiratory failure who were extubated prior to (>24hrs) decannulation of ECMO at our institution in 2015.

RESULTS: Four patients met the criteria. Three patients required ECMO therapy secondary to acute hypoxic respiratory failure secondary to infectious causes. Patient 1 was on VV ECMO for 13 days and was extubated on day 10 of ECMO therapy. Patient 2 was on VV ECMO for 6 days and was extubated on day 4 for ECMO therapy. Patient 3 was on VV ECMO for 25 days and was never intubated. The fourth patient was placed on ECMO therapy secondary to asthma exacerbation for 1 day and was extubated and weaned off ECMO the very next day. All patients had f/up visits as outpatient in our clinic where they had no residual pulmonary symptoms and their radiographs showed continued improvement in their chest xrays to their baseline. All patients requiring intubation were placed on high flow nasal cannula post extubation and later on weaned off.

CONCLUSIONS: Early extubation helps in preventing ongoing ventilator associated lung injury in patients with acute respiratory failure. Oxygenation can be effectively achieved by use of high Flow nasal cannula whereas VV ECMO can be utilized for CO2 removal.

CLINICAL IMPLICATIONS: With the advent of ECLS therapy aggressive ventilator weaning should be attempted to avoid the physiologic effects of ventilator associated lung injury.

DISCLOSURE: The following authors have nothing to disclose: Killol Patel, Harish Seethamraju

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