Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023)
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Objective This consensus aims to provide evidence-based recommendations on common questions in the diagnosis and treatment of acute respiratory failure (ARF) for critically ill cancer patients.Methods We developed six clinical questions using the PICO (Population, Intervention, Comparison, and Outcome) principle in diagnosis and treatment for critical ill cancer patients with ARF. Based on literature searching and meta-analyses, recommendations were devised. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) method was applied to each question to reach consensus in the expert panel. Results The panel makes strong recommendations in favor of (1) metagenomic next-generation sequencing (mNGS) tests may aid clinicians in rapid diagnosis in critically ill cancer patients suspected of pulmonary infections; (2) extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients but may benefit highly selected patients after multi-disciplinary consultations; (3) cancer patients who have received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy; (4) critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy; and (5) high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARFs. A weak recommendation is: (6) for critically ill cancer patients with ARF caused by tumor compression, urgent chemotherapy may be considered as a rescue therapy only in patients determined to be potentially sensitive to the anticancer therapy after multidisciplinary consultations. Conclusions The recommendations based on the available evidence can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.Severe hypoxic respiratory failure is a leading cause of neonatal mortality in Chile. Extracorporeal membrane oxygenation improves survival in neonates with hypoxic respiratory failure.To determine the impact of the establishment of a Neonatal Extracorporeal Membrane Oxygenation Program on the outcome of newborns with severe hypoxic respiratory failure in a developing country.Data of newborns (birthweight > 2,000 g and gestational age ≥ 35 wk) with hypoxic respiratory failure and oxygenation index greater than 25 were compared before and after extracorporeal membrane oxygenation was available. Extracorporeal membrane oxygenation was initiated in infants with refractory hypoxic respiratory failure who failed to respond to inhaled nitric oxide/high-frequency oscillatory ventilation.Data from 259 infants were analyzed; 100 born in the pre-extracorporeal membrane oxygenation period and 159 born after the extracorporeal membrane oxygenation program was established. Patients were similar in terms of risk factors for death for both periods except for a higher oxygenation index and a greater proportion of outborn infants during the extracorporeal membrane oxygenation period. Survival significantly increased from 72% before extracorporeal membrane oxygenation to 89% during the extracorporeal membrane oxygenation period (p < 0.01). During the extracorporeal membrane oxygenation period, 98 of 159 patients (62%) with hypoxic respiratory failure were rescued using inhaled nitric oxide/high-frequency oscillatory ventilation, whereas 61 (38%) did not improve; 52 of these 61 neonates were placed on extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survival rate to discharge was 85%. After adjusting for potential confounders, the severity of the pretreatment oxygenation index, a late arrival to the referral center, the presence of a pneumothorax, and the diagnosis of a diaphragmatic hernia were significantly associated with the need for extracorporeal membrane oxygenation or death.The establishment of an extracorporeal membrane oxygenation program was associated with a significant increase in the survival of newborns more than or equal to 35 weeks old with severe hypoxic respiratory failure.
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体外膜氧合（ECMO）又称体外生命支持（ECLS）技术，能够快速为急性呼吸和（或）循环衰竭患者提供稳定血流动力学支持，成功挽救部分危重症患者生命。但ECMO救治对象病情极为危重，技术本身又具有高创伤性、高消耗性和高专业性等特点。因此，如何能使更多危重症患者从ECMO辅助中获益，充分利用好ECMO技术应是每位ECMO从业人员应面对的机遇和挑战。.
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Extracorporeal membrane oxygenation (ECMO) has been a successful treatment (82% survival) in over 5000 neonates with severe respiratory failure (80% predicted mortality without ECMO). ECMO is prolonged extracorporeal cardiopulmonary bypass achieved by extrathoracic vascular cannulation using a modified heart-lung machine. ECMO is currently the treatment of choice for full-term newborns with severe respiratory failure. The report summarizes indications, resulting complications, and future applications of neonatal ECMO.
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Extracorporeal membrane oxygenation (ECMO) is a kind of extra life support technique that can support cardiac and pulmonary function in a relatively long time. With the application of nitric oxide, pulmonary surfactant and high frequency ventilation, the use of ECMO in neonatal respiratory failure decreased. Although received these treatment, there are some newborn with respiratory failure still required ECMO at last. On this paper, the application of ECMO in neonatal respiratory failure from foreign medical institute was introduced, and compared with the domestic situation, in order to improve the application of ECMO in neonatal respiratory failure.
Key words:
Extracorporeal membrane oxygenation; Respiratory failure; Infant, newborn
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Objective: To report a case of pH1N1 viral infection presenting as heart failure requiring mechanical extracorporeal life support. Design: Case report. Setting: Pediatric intensive care unit at a regional children's hospital. Patient: Obese 15-yr-old boy who presented with pH1N1-related cardiomyopathy and respiratory failure that required extracorporeal membrane oxygenation. Interventions: Extracorporeal membrane oxygenation, echocardiography, high-frequency oscillating ventilation. Measurements and Main Results: Discovery of severe dilated cardiomyopathy and respiratory failure. Conclusions: Patients with pH1N1 may present in profound heart failure in addition to respiratory failure. Extracorporeal membrane oxygenation may play an important role in managing these complex patients.
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This review discusses the use of extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure in neonates. After briefly reviewing the early history of neonatal ECMO, the authors describe the respiratory diagnoses most often treated with ECMO and the manner in which affected neonates are deemed to have “failed” conventional therapies and thus require ECMO. After reviewing the most common indications for ECMO, factors that influence the timing of conversion to extracorporeal life support, as well as criteria that may exclude patients from receiving ECMO therapy, are described. At the conclusion of this article, the authors discuss the long-term outcomes of neonates whose respiratory disease was treated with ECMO and the costs associated with that care.
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Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass adapted for long-term use. Blood is drained from the patient, pumped through an artificial lung or membrane where gas exchange is augmented, and then re-infused back to the patient. ECMO provides support for the neonate with severe respiratory failure so that potentially deleterious ventilator settings can be minimized and the disease process given time to resolve. Survival rates and long-term neurodevelopmental outcomes in newborns supported with ECMO for hypoxemic respiratory failure remain favorable, although the use of ECMO has decreased in the most recent decade because of the availability of alternative treatment options.
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Objective: Extracorporeal membrane oxygenation (ECMO) is increasingly used as rescue therapy for patients with severe acute respiratory distress syndrome (ARDS). We report our experience with this therapy and evaluate the effect of different cannulation strategies.
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