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Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Only a few original papers on respiratory issues have been published so far in 2023. The vast majority are systematic reviews and meta-analyses of already published studies. In March 2023, the European Society for Intensive Care Medicine (ESICM) issued recommendations for the management of acute respiratory distress syndrome (ARDS). In the first part of this text, a very basic summary of recommendations according to individual domains is described. Extracorporeal membrane oxygenation (ECMO) is an intervention that has received much attention in recent years, mainly due to the COVID-19 pandemic. The last randomized trial (EOLIA trial) did not confirm a mortality benefit [1]. However, the subsequent Bayesian analysis of the data of this study brought a posterior probability of a mortality benefit of ECMO support compared to conventional therapy in a selected subgroup of patients with early use of ECMO in patients with severe ARDS [2]. In the second part of the article, we summarize publications related to the effect of ECMO support on several specific groups of diseases. These are patients with polytrauma, life-threatening bronchial asthma, burn trauma, and kidney transplant patients. The third part of the article deals with various aspects of anticoagulant therapy used in ECMO support, including its monitoring and comparison of the effect of heparin and bivalirudin. The fourth part describes a publication evaluating the effectiveness of extracorporeal CO2 removal (ECCO2R) from the point of view of enabling ultraprotective mechanical ventilation in patients with moderate to severe ARDS. The fifth part deals with the relationship of selected pathophysiological aspects to clinical practice and results. It is an investigation of exhaled air analysis for determining the clinical outcome of patients with ventilator-associated pneumonia (VAP). Furthermore, there is also a description of the relationship between dead space ventilation and the prognosis of patients with ARDS. The sixth part deals with the optimization of artificial lung ventilation settings based on the use of transpulmonary pressure measurement. The next part of the article, the seventh, deals with a meta-analysis of the comparison of the effectiveness of non-invasive forms of mechanical ventilation and other methods, such as high-flow oxygen therapy and conventional oxygen therapy. The penultimate section relates to the effect of various forms of nebulization therapy, such as the use of heparin in patients with COVID-19 pneumonia, and in the general population of patients on mechanical ventilation, and the use of volatile anesthetics in patients with refractory bronchospasm. In the last section, the text deals with various aspects of interventions in patients with severe respiratory failure who remain conscious. This invloves the effect of the so-called awake prone position and awake extracorporeal oxygenation support. [ABSTRACT FROM AUTHOR]

Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Refractory circulatory shock is associated with excessive mortality in critically ill patients. Non-adrenergic vasopressors, including methylene blue, are often considered as an adjuvant therapy to the ordinary vasopressor treatment. In this case report we present a case of successful use of methylene blue reversing refractory septic shock in a patient on veno-arterial extracorporeal membrane oxygenation due to septic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Acute respiratory failure, a condition frequently fraught with haemodynamic instability, is one of the most frequent reasons for admission to the intensive care ward. Obligatory questions in every patient concern the left ventricular function and assessment of the left atrial and left ventricular filling pressures. The prognosis and management of respiratory failure also depend on assessment of the right ventricular function and pulmonary circulation. A complex echo protocol is warranted to judiciously decide on the treatment strategy including optimization of the patient's preload, contractility, heart rate and afterload. This allows for effective treatment of respiratory disequilibrium, which can continue to be monitored by means of ultrasound. Monitoring of the lung parenchyma and pleural space enables the physician to obtain additional data supporting the echocardiography findings, assisting the decision making on the ventilation strategy, the need for bronchoscopy, pleural drainage and to determine optimal patient position including prone postitioning. The appropriateness of prescribed therapy for the acute respiratory failure management can then be monitored by bedside echocardiography and lung ultrasonography in the attempt to optimize pulmonary gas exchange without haemodynamic alteration, and also to improve the patient's haemodynamic status without adding an unnecessary burden to the respiratory system. As the respiratory failure responds to treatment, echocardiography can then assist with weaning and termination of ventilatory support. Where the respiratory failure is critical, rapid assessment with echocardiography and chest ultrasound helps in the decision-making as to whether to proceed to extracorporeal lung assist (ECLS) support and if adopted, its optimal configuration. ECLS requires ultrasound modalities for correct indication, management and weaning of this mode of support. Echocardiographic monitoring of patients in acute respiratory failure is indispensable and an ultrasonic device should be considered essential equipment for every intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: Retrospective evaluation of a sample of 21 neonates and children treated with ECMO. Design: Observational, retrospective with prospective data collection. Setting: Paediatric and neonatal intensive care unit of a teaching hospital. Materials and methods: Between October 2010 and present, extracorporeal membrane oxygenation support was initiated in 21 patients based on meeting the indication criteria (12 neonates, 9 children). According to the etiology and severity of the cardiorespiratory failure, veno-artehal (V-A) ECMO was indicated in 57% of the patients (83% of the neonates, 22% of the children) - the remaining patients were treated with veno-venous (v-V) ECMO. Results: The survival rate was 58% in the neonatal group and 77% among the children. This work contains a brief comparison with some results of other international studies. Due to sample size, no statistical evaluation was performed. Conclusion: The authors demonstrate on the published sample that provision of the discussed care is needed in the Czech Republic. Many parameters of the presented outcomes are - in spite of the small sample size - comparable with the outcomes of the international registry. [ABSTRACT FROM AUTHOR]

In severe cases of respiratory failure it may be impossible to achieve adequate gas exchange while using protective settings of mechanical ventilation, which in turn may result in further lung damage. Cardiac bypass machines for extracorporeal membrane oxygenation (cardiac bypass) have been used in the past for rescue management of patients with critical hypoxaemia, however their use was limited to centres with cardiac surgery facilities and the complication rates were high. New technology, primarily aimed at supporting the respiratory function, has been introduced to clinical practice in the recent years -- 'pulmonary' extracorporeal membrane oxygenation (ECMO). Improved oxygenation and CO2 elimination allows ventilator settings to be less aggressive and the term 'ultra-protective mechanical ventilation' has emerged. ECMO has become the default management of some conditions and in some groups of patients (such as COPD patients or lung transplant awaiting patients) it has allowed the patients to stay off mechanical ventilation. This article is aimed at the principles, indications and uses of ECMO. [ABSTRACT FROM AUTHOR]

Current knowledge of the extracorporeal membrane oxygenation (ECMO) method, which is generally used in children, is reviewed in this article. A change in the spectrum of diseases indicated for ECMO therapy in children has been well documented during the past fifteen years. The number of chronically ill children undergoing ECMO is rising, the percentage of co-morbidity-free survivors out of the total ECMO survivor population has increased, survival among chronically ill children has decreased whereas the total number of treated children by ECMO has increased. The incidence of the veno-venous ECMO modality has risen compared to the venous-arterial ECMO modality which may lead to a significantly higher survival documented in children treated by veno-venous ECMO. [ABSTRACT FROM AUTHOR]

Mechanical circulatory support devices (MCS) constitute an important part of acute and chronic heart failure therapy. The principal objective of the MCS implantation is to restore adequate circulation including optimal oxygen delivery to the tissues with subsequent normalization of tissue functions. The most frequent indications for MCS implantation are bridge-to-heart transplantation, and bridge-to-recovery after various types of myocardial injury (e.g., acute myocardial infarction, myocarditis, extensive cardiac surgical procedures). In the Czech Republic, the most frequently used MCS devices are the intraaortic balloon pump, ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO). [ABSTRACT FROM AUTHOR]

Objective: The authors demonstrate a premature birth of a pregnant woman, who was for heavy Respiratory Distress Syndrome (ARDS), on the basis of pulmonary infection H1N1, connected to venovenous extracorporeal membrane oxygenation (ECMO). Patient spontaneously delivered after being connected to the ECMO for 30 hours., Setting: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague., Design: Case report., Conclusion: Preterm birth at 24 week of pregnancy. During pregnancy, the labor and postpartum was the pregnant woman connected to extracorporeal membrane oxygen therapy.

Mechanical cardiac support systems represent rapidly developing segment of current cardiology. Several support systems have been recently introduced into the clinical practice for the therapy of cardiogenic shock or refractory non-tolerated ventricular tachycardia, for the support of high-risk catheter interventions, and even for the support of cardiopulmonary resuscitation. These new technologies enable quick set-up and introduction even in emergency situations and may be used not only as a ventricular assist device but also as a replacement of seriously damaged heart function. At the present time, number of centers have several different mini-invasive cardiac support systems at disposal in specific patients. This paper is a brief overview of the currently available mini-invasive mechanical cardiac support systems and describes their advantages and disadvantages.

The authors describe the case of newborn with laparoschisis in whom severe idiopathic pulmonary hypertension during postoperative period developed and initiation of extracorporeal membrane oxygenation (ECMO) to maintain circulatory stability and adequate oxygenation was necessary. ECMO was performed for 75 hours with maximum extracorporeal support up to 50% of cardiac output (Biomedicus pump BP 50, Jostra oxygenator M8). Patient was successfully weaned and switched to conventional ventilation and nitric oxide inhalation with consequent extubation. No bleeding complications were observed during ECMO in connection with surgical repair of laparoschisis.

Objective of Study: Evaluation of success of extracorporeal membrane oxygenation, EMCO) in the treatment of acute respiratory failure in mature neonates., Type of Study: Clinical pilot study of the EMCO centre., Setting: Institute for the Care of Mother and Child, Prague., Material and Method: In 12 consecutive patients with severe acute respiratory distress syndrome and/or circulatory failure of different etiology who met the indication criteria the method of venoarterial EMCO was used., Results: Venoarterial extracorporeal membrane oxygenation was successful in 75% patients who survived. Four patients died (1x syndrome of cerebral death associated with severe hypoxic-ischaemic encephalopathy, 2x severe irreversible haemorrhage, into the abdominal and thoracic cavity, 1x periventricular intraventricular haemorrhage grade III.). The mean period of EMCO was 71.4 +/- 31.7 hours (range 25-130 hours). On comparison of the surviving group (S) and the non-surviving group (NS) there was a significant difference in the necessity of continuous inotropic adrenaline support during EMCO. In patients who died necropsy confirmed irreversible multiorgan failure., Conclusion: In indicated cases extracorporeal membrane oxygenation remains the method of choice in critically ill mature neonates. A prognostically adverse factor is the necessity of inotropic support and haemodialysis during EMCO.

The objective of the investigation was to evaluate the success of a new therapeutic protocol in patients with congenital diaphragmatic hernia (CDH). During the period from 1/1994 till 12/1998 41 patients with CDH were admitted. In 36 patients (88%) left-sided CDH was diagnosed, in 4 patients (10%) right-sided CDH and one neonate (2%) bilateral CDH. Fifteen cases (37%) of CDH were assessed prenatally. Twenty-two children (54%) were treated by inhalation of nitric oxide (INO) and 4 patients (10%) by extracorporeal membrane oxygenation. The total incidence of associated developmental defects was 20% and the total mortality 34%. On comparison of the surviving (group S, n = 27) and the non-surviving NS, n = 14) patients statistically significant differences were found in the Apgar score during the first minute (S: 5.9 +/- 0.5 vs. NS: 3.4 +/- 0.7, p < 0.008), in the oxygenation index (OI) two hours after admission (S: 11.9 +/- 2.9 vs. NS: 27.7 +/- 8.3, p < 0.03), in the alveolo-arterial oxygen difference (AaDO2) 2 hours and 12 hours after admission (S: 369 +/- 47 torr and 237 +/- 47 torr resp. vs. NS: 552 +/- 29 torr and 557 +/- 26 torr resp., p < 0.02) and in the need to start extracorporeal membrane oxygenation (S: 3.7% vs. NS: 21.4%, p < 0.009). The investigation confirmed a reduced mortality of neonates with CDH by introducing new therapeutic methods. Risk factors are early prenatal diagnosis, the presence of associated developmental defects, high values of oxygenation and ventilation with the necessity to start nitric oxide inhalation.

The authors present a case dealing with the treatment of a congenital diaphragmatic hernia. The procedure comprises surgery, extracorporeal membrane oxygenation--ECMO, classical and non-conventional pulmonary ventilation and pharmacological treatment. By using these methods it is possible to treat successfully a certain group of neonates with a congenital diaphragmatic hernia.

The authors describe their initial experience, organization, and problems associated with the development of an EMCO centre. Its main activities are those of a neonatal ECMO centre (to a smaller extent paediatric ECMO and ECCO2R-LF PPV of adults) during the first 4 months of its existence. During the period the ECMO centre was contacted in 10 instances. The referring department indicated the ECMO centre correctly in six instances. However, at least in two instances too late and the patients died (during priming of the ECMO circuit or transport could not be implemented because of the critical condition). In two instances, however, the ECMO staff failed as it was unable to ensure a minimum of seven days of safe operation of ECMO and therefore ECMO was not provided. Based on this experience the authors present an organizational model of the ECMO unit which is formed ad hoc when needed and comprises specialists of various professions from the sphere of emergency medicine. The main purpose of the present paper is to inform referring departments on the indications, selection criteria, contraindications of ECMO in neonates and children and to ensure thus not only smooth communication between the ECMO centre and the referring department but in the first place early referral to the ECMO centre at a time when transport is not yet a problem.