Thanks. Seems surprising to me in they quote 40% survival, but I don’t know. 8 day ECMO run for ARDS is incredibly short, so maybe they had aggressive cannulations to fudge those numbers?
P-SILI isn't negative pressure pulmonary edema, it's the lung injury caused by high transpulmonary pressures driven by the patient rather than the ventilator (or both if they're ventilated and spontaneously breathing).
Their driving pressure isn't 8 though, it's 8 plus Pmus.
Ok so do we think that is enough to warrant paralysis then since I cant really measure it on these patients? How long should we paralyze people not responding to sedation with high respiratory drive to keep their volumes in check before we are doing more harm than good? We know with COVID that it can be 2-4 weeks before the lungs recover enough to even tolerate a trach let alone getting to an LTACH. I saw one person who was paralyzed for a week with a decent outcome but the vast majority who are paralyzed that long end up with fibrotic end stage lung disease and die on the vent.
Well then, I don’t believe in it. Negative pressure pulmonary edema is like a type of self induced lung injury although doesn’t seem to be in your opinion. It’s the closest I have ever seen to self indunced lung injury and I don’t buy into the rest. Otherwise all these fat patients who use BiPap and CPAP every night would be walking around with injuries all the time as already stated above by another doc.
Exactly. And then you get CO2s in the 80-100s and pHs around 7 especially in ARF and then bad things happen.
Rare to find any that do them. Seems like many want them up and around and not bedridden close to death. That’s the jest I have heard in my region of the world.
Well the ECMO mortality at the hospital I currently am is over 80%. However sample size is less than 20 so far and this place is literally where patients come to die. Dangerous from top to bottom and I am done this week. Thank you Jesus.
Has not come up so I don’t know.
That’s disgusting.
Lung xplant is a totally different animal because of microbial exposure. The only organ with worse outcomes is small bowel transplant and if that organ fails people can go back on to TPN at least instead of guaranteed death.
www.ncbi.nlm.nih.gov
Lung xplant is a totally different animal because of microbial exposure. The only organ with worse outcomes is small bowel transplant and if that organ fails people can go back on to TPN at least instead of guaranteed death.
People who cant walk before transplant do much worse.
The Utility of Preoperative Six-Minute-Walk Distance in Lung Transplantation
Rationale: The use of 6-minute-walk distance (6MWD) as an indicator of exercise capacity to predict postoperative survival in lung transplantation has not previously been well studied.Objectives: To evaluate the association between 6MWD and postoperative ...
Consider yourself lucky--definitely was glad to get away from this super sick population when I exited training. They get bizarre post-op infections, can have 4-6 month+ hospitalizations, super weird **** like hyper ammonia syndrome requiring crrt for months etc.
I don't think it's enough to warrant paralysis. Maybe more sedation in the short term? We don't know what to do with these patients. At best we have experimental data in animals that show it is harmful, but hard to know what to do with real patients who have a high drive.
I believe in NPPE just it isn't the type of injury that I was referring to with patients who have self-inflicted driving perssures. your bipap/cpap patients should have normal lung compliance so there shouldn't be any lung injury. Furthermore what we do know about P-SILI is that the lung has to be injured (e.g. from pneumonia, aspiration, non pulmonary ARDS) PLUS high driving pressures for there to be harm.
Well maybe the 60 days is a little much no? Are you all doing that on Covid patients? Yeah, I know it’s expensive, but I am thinking that if there is government funding of a public/county hospital, that helps, no?
Quite frankly this is the first I have heard of it. As for me, it’s just common sense that if an awake person is pulling giant TV with lots of pressure support, then naturally they don’t need all that support. I simply turn it down and move on. I am simple and am not well versed in lots of studies and can’t quote you papers. I try to keep things practical.
We had one w a bad reputation. However what stood out to me was the high doses of Vaso he used.
Why can’t you just keep the volumes in check by adjusting their pressures?
I cannot say I have experienced this that cannot be controlled with PC and decreasing their Pi on three sedatives/narcotics. The only people who do this are awake people on BiPap on at most Precedex. Not patients on the ventilator. Do you think that maybe you are intubating too early? It they have this drive and muscle tone to pull such giant volumes, why are they intubated?
I would say I encounter one of these people out of 30 or so in the 200+ vented covids I have cared for. Most of them are intubated for bipap dependence and in some cases extremis from being left on bipap for too long.
You make already know this, but this interesting phenomenon is caused by overgrowth of Ureaplasma urealyticum overgrowth/pneumonia.
