לפניכם ההנחיות, בהמשך ראו שאלות בנושא ששלח פרופ' רענני לפרופ' לורוסי , ותשובותיו
בעקבות ההנחיות והוובינר שהתקיים בנושא שלח פרופ' רענני מספר שאלות לפרופ' רוברטו לורוסו :
A). What are the general principles? Same, like for ARDS? "Rest lung" concept?
B). What are the specific recommendations? PEEP, PIP, FiO2, frequency, tidal volume, minute volume, using of NO?
C). What are indications for weaning from the ECMO?
D) the last question: average duration of ventilation and ECMO in jour hospital?
E) how do you monitor anticoagulation? PTT? ACT?
להלן תשובותיו של פרופ' לורוסו:
A) and B) plateau pressure < 30 cm H20, RR 6-12 bpm, PEEP 10-15 cm H2O, driving pressure <15 cm H2O, and FiO2 <50% to maintain saturations >80-85%.
C) Usual way, sweep gas to 0 L/min, and mechanical ventilator set up at VT≤ 6 mL/kg , PPl≤ 25 cmH2O, PEEP ≤ 16 cmH2O, FiO2≤ 0.5, pH > 7.3, SaO2> 88%). If gas exchange is adequate for a 12-24 h period, the patient can be decannulated
D) long, 2-3 weeks. However, lungs are more compliant than other type of ARDS
E) Be careful to dry up to much the patient since you may predispose to venous thrombosis and APE.
I hope that this was helpful, m but it is nothing really different from standard V-V ECMO. In any case, please, contact at your convenience, should any need arise.