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Use of extracorporeal membrane oxygenation in combination with high‐frequency oscillatory ventilation in post‐traumatic ARDS
Author(s) -
GOTHNER M.,
BUCHWALD D.,
SCHLEBES A.,
STRAUCH J. T.,
SCHILDHAUER T. A.,
SWOL J.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12065
Subject(s) - medicine , ards , extracorporeal membrane oxygenation , anesthesia , fraction of inspired oxygen , pelvic fracture , blunt trauma , surgery , lung , mechanical ventilation , pelvis
Acute lung injury ( ALI ) and acute respiratory distress syndrome ( ARDS ) are life‐threatening complications in trauma patients. Despite the implantation of a veno‐venous extracorporeal membrane oxygenation (vv ECMO ), sufficient oxygenation (arterial SaO 2 > 90%) is not always achieved. The additive use of high‐frequency oscillation ventilation ( HFOV ) and ECMO in the critical phase after trauma could prevent the occurrence of life‐threatening hypoxaemia and multi‐organ failure. We report on a 26‐year‐old female ( I njury S everity S core 29) who had multiple injuries as follows: an unstable pelvic fracture, a blunt abdominal trauma, a blunt trauma of the left thigh, and a thoracic injury. Three days after admission, the patient developed fulminant ARDS (Murray lung injury score of 11 and H orovitz‐ I ndex <80 mmHg), and vv ECMO therapy was initiated. The H orovitz‐ I ndex was <80 mm H g, and the lung compliance was minimal. With HFOV , almost complete recruitment of the lung was achieved, and the fraction of inspired oxygen ( FiO 2 ) was significantly reduced. The pelvic fracture was treated non‐operatively. The HFOV was terminated after 3 days, and the ECMO was stopped after 19 days.