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Abstract
BACKGROUND: Pediatric patients with ARDS will on occasion need venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support. As these patients recover, they may benefit from lung recruitment maneuvers including flexible bronchoscopy (FB). The objective of this study was to assess the clinical course of patients who underwent FB while on VV-ECMO for ARDS.
METHODS: This was a secondary analysis of a retrospective multi-center cohort at 10 United States pediatric academic quaternary care centers. Data were collected on 204 subjects age 14 d–18 y on VV-ECMO.
RESULTS: 271 FBs were performed on 129 (63%) subjects. Pre-FB tidal volume was 1.8 mL/kg compared to 2.22 mL/kg following FB (P = .007). Dynamic compliance also improved from pre-FB to post-FB (2.23 vs 3.04 mL/cm H2O, P = .005). There was a low incidence of complications following FB (3.1%). Subjects in the FB group had fewer ECMO-free days (EFDs) (17.9 vs 22.1 d, P < .001), fewer ventilator-free days (VFDs) (40.0 vs 46.5 d, P = .001), and longer ICU length of stay (LOS) (18 vs 32 d, P < .001). Subjects in the early versus late FB group had more EFDs (19.4 vs 15.2 d, P = .003), more VFDs (43.0 vs 34.0 d, P = .004), and shorter ICU LOS (27.5 vs 35.5 d, P = .045). Mortality in the subjects who had at least one FB was 27.1% compared to 40% in the subjects who did not have a FB while on VV-ECMO (P = .057).
CONCLUSIONS: FB can be performed on patients while anticoagulated on VV-ECMO with a low incidence of complications. FB may be beneficial especially when performed early in the course of VV-ECMO.
- flexible bronchoscopy; venovenous ECMO
- pediatric ARDS
- mechanical ventilation
- pulmonary clearance
- lung recruitment
Footnotes
- Correspondence: Elizabeth Rosner DO, 100 Michigan St NE Grand Rapids, MI 49503; office phone 616–267-0340. E-mail: Elizabeth.rosner{at}helendevoschildrens.org
The authors have disclosed no conflicts of interests.
The study was performed at Helen DeVos Children’s Hospital, Riley Hospital for Children at IU Health, Cincinnati Children’s Hospital, Children’s Hospital of Philadelphia, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Children’s Medical Center of Dallas, Children’s Healthcare of Atlanta, Johns Hopkins Children’s Center, Le Bonheur Children’s Hospital, and Duke Children’s Hospital. Each center is a member of the Pediatric ECMO subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators Network and the Extracorporeal Life Support Organization.
- Copyright © 2022 by Daedalus Enterprises
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