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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Extracorporeal membrane oxygenation (ECMO) is a complex life support technique for severe pulmonary or cardiopulmonary failure, developed through modification of the heart lung bypass machine [1]. The technique of ECMO involves oxygenating blood outside the body and, thus, obviates the need for gas exchange in the lungs. The technique is categorised as either veno-venous (VV) or veno-arterial (VA), depending on the type of cannulation. In VV ECMO, deoxygenated blood is drained and oxygenated blood re-infused via venous sites. In neonates, this is achieved by placing a double lumen cannula in the right internal jugular vein (Figure 1). In VA ECMO, deoxygenated blood drawn from the right internal jugular vein is returned oxygenated via the right common carotid artery. While VV ECMO provides support purely with gas exchange, VA ECMO also supports the heart.
Modern Rehabilitation Techniques for COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
Patients who have suffered from COVID-19 to a certain severe degree (refractory respiratory failure or multiorgan failure) may need to receive extracorporeal membrane oxygenation (ECMO) intervention, and then carry out rehabilitation training (early motion and respiratory training), which can improve the prognosis.
Care of Critically Ill Patients with HIV
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Joseph Metmowlee Garland, Andrew Levinson, Edward Wing
For patients that are mechanically ventilated for pneumonia, it is important that best practices be followed to avoid increased mortality from mechanical ventilation. In mechanically ventilated patients with pneumonia who meet current definitions for ARDS [90], a ventilation strategy using low tidal volumes of 6–8 cc/kg ideal body weight should be followed [91,92]. One large retrospective study found that lower tidal volume ventilation is independently associated with reduced mortality in HIV-infected patients with acute lung injury and respiratory failure [91]. In addition, positive end-expiratory pressure (PEEP) should be used to lower the fraction of inspired oxygen administered (FIO2) to safe levels to avoid potential oxygen toxicity [93]. If peak pressures on the ventilator remain high, or if there is difficulty with lowering the FIO2 or ventilating at targeted low tidal volumes utilizing a lung-protective strategy, alternative therapies such as extracorporeal membrane oxygenation (ECMO) should be considered. There may be a benefit to the early use of neuromuscular blockade and proning in patients who develop severe ARDS [94,95].
Heart of lymphoma: a case report
Published in Acta Cardiologica, 2023
Annemie Jacobs, Thomas Gevaert, Wim Volders, Dieter De Cleen, Katrien Van Kolen, Frank Cools, Steven Hellemans
The current standard of treatment of a mediastinal DLBCL is rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). When there is septal involvement by DLBCL, complete heart block can be seen [8]. Given the risk of myocardial rupture during the chemotherapy treatment, close monitoring is necessary. Furthermore, DLBCL tumours localised to the heart can also be treated with radiotherapy [5]. Utility of surgery or extracorporeal membrane oxygenation (ECMO) in this patient population can address immediate hemodynamic instability but is high risk and not standard or care. Surgical resection is only possible at early stages of disease. Furthermore, surgery can also be palliative to help correct hemodynamics and improve blood flow to the lungs in the case of right ventricle outflow obstruction [1]. In this case, treatment options were discussed with the patient and his family members, and comfort care was preferred.
Research progress of portable extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2023
Yuansen Chen, Duo Li, Ziquan Liu, Yanqing Liu, Haojun Fan, Shike Hou
Extracorporeal membrane oxygenation (ECMO), as an effective extracorporeal life support technology, is mainly used in patients with acute cardiopulmonary failure. In recent years, with the rapid development of ECMO technology, its clinical indications have gradually increased, and it has been applied in the treatment of many critical diseases [1]. Its good therapeutic effects have been achieved in the rescue and treatment of patient with severe respiratory failure, cardiogenic shock, cardiac arrest, organ transplantation, poisoning and trauma [2–6]. As the novel coronavirus disease-19 (COVID-19) epidemic has rapidly spread around the world since 2019, ECMO has played an active role in the treatment of critically ill patients with COVID-19, which has been generally accepted and recognized by the public. According to the report of the extracorporeal life support organization (ELSO), in 2020, the number of ECMO transfers worldwide would reach more than 170,000 [7].
Racism and Bioethics: The Myth of Color Blindness
Published in The American Journal of Bioethics, 2021
Consider the question in the example of the prognosis for a particular medical condition. Imagine two virtually identical patients, with virtually identical medical history, health status, and current clinical condition. One of these hypothetical patients is white and one is Black. Consider further that we were asked to opine on the prognosis for their medical condition. Many models exist with which to create probabilistic predictions of certain clinical outcomes. The most widely used model today is the Sequential Organ Failure Assessment (SOFA) score, a numerical score created from clinical variables; SOFA uses multiple clinical variables, including level of oxygenation, certain blood counts, and measures of kidney function, to predict prognosis in critically ill patients (Raith et al. 2017). In the context of the COVID-19 pandemic, it has been seen as a valuable tool with which to triage the deployment of life-sustaining treatments, including mechanical ventilators and extracorporeal membrane oxygenation (ECMO), in the event of overwhelming numbers of critically ill patients. Patients with a SOFA score predicting better life expectancy, ostensibly based solely on objective, clinical data, would have priority in triage for access to these life-sustaining treatments.