Page 663 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

482 PART 4: Pulmonary Disorders

KEY REFERENCES CHAPTER Acute-on-Chronic
• Australia and New Zealand Extracorporeal Membrane Oxygenation Respiratory Failure
(ANZ ECMO) Influenza Investigators, Davies A, Jones D, et al. 54
Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) Ivor S. Douglas
acute respiratory distress syndrome. JAMA. 2009;302:1888-1895.
• Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for
ARDS in adults. N Engl J Med. November 17, 2011;365(20):1905- KEY POINTS
1914. Review.
• Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal • Acute-on-chronic respiratory failure (ACRF) occurs when often
minor, although commonly multiple, insults cause acute deteriora-
membrane oxygenation in adults with severe respiratory failure: a
multicenter database. Intensive Care Med. 2009;35(12):2105-2114. tion in a patient with chronic respiratory insufficiency.
• Chalwin RP, Moran JL, Graham PL. The role of extracorporeal • ACRF is usually seen in patients known to have severe chronic
membrane oxygenation for treatment of the adult respiratory dis- obstructive pulmonary disease (COPD), but occasionally it mani-
tress syndrome: review and quantitative analysis. Anaesth Intensive fests as cryptic respiratory failure or postoperative ventilator
Care. 2008;36(2):152-161. dependence in a patient with no known lung disease.
• Dalton JH, MacLaren G. Extracorporeal membrane oxygenation • The wide variety of causes of ACRF may be compartmentalized into
in pandemic flu: insufficient evidence or worth the effort? Crit causes of incremental load, diminished neuromuscular competence,
Care Med. 2010;38(6):1484-14845. or depressed drive, superimposed on a limited ventilatory reserve.
• Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski • Intrinsic positive end-expiratory pressure (PEEPi) is a central
MW. Extracorporeal life support. Clinical review. BMJ. November contributor to the excess work of breathing in patients with ACRF.
2, 2010;341:c5317. • The most important therapeutic interventions are administra-
• Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O’Brien CR, tion of oxygen, bronchodilators, corticosteroids, and noninvasive
Rubenfeld GD. Hospital volume and the outcomes of mechanical positive-pressure ventilation (NIV).
ventilation. N Engl J Med. 2006;355(1):41-50. • NIV can be used in most patients to avoid intubation and has been
• Langer T, Vecchi V, Belenkiy SM, et al. Extracorporeal gas shown to improve survival.
exchange and spontaneous breathing for the treatment of acute • The decision to intubate a patient with ACRF benefits from clinical
respiratory distress syndrome: an alternative to mechanical venti- judgment and a bedside presence. Hypotension and severe alkale-
lation? Crit Care Med. 2014;42:e211-e220. mia commonly complicate the immediate periintubation course,
• Lynch JE, Hayes D Jr, Zwischenberger JB. Extracorporeal CO(2) but they are usually avoidable. However, delaying intubation when
removal in ARDS. Crit Care Clin. July 2011;27(3):609-625. NIV is ineffective may worsen outcomes.
• Mitchell MD, Mikkelsen ME, Umscheid CA, Lee I, Fuchs BD, • Ventilator settings should mimic the patient’s breathing pattern,
Halpern SC. A systematic review to inform institutional decisions with a modest respiratory rate (eg, 20/min) and small tidal volume
about the use of extracorporeal membrane oxygenation during (eg, 450 mL); some positive end-expiratory pressure (eg, 5 cm H O)
the H1N1 influenza pandemic. Crit Care Med. 2010;38:1398-1404. should be added. 2
• Napolitano LM, Park PK, Raghavendran K, Bartlett RH. • Prevention of complications such as gastrointestinal hemorrhage,
Nonventilatory strategies for patients with life-threatening 2009 venous thrombosis, and nosocomial infection is a crucial compo-
H1N1 influenza and severe respiratory failure. Crit Care Med. nent of the care plan.
2010 April;38(4 suppl):e74-e90. Review. • The key to liberating the patient from the ventilator is to increase
• Napolitano LM, Park PP, Sihler KC, et al. Centers for Disease neuromuscular competence while reducing respiratory system load.
Control and Prevention (CDC). Intensive care patients with severe
novel influenza A (H1N1) virus infection—Michigan, June 2009. • In selected patients, extubation to NIV despite failed spontaneous
MMWR Morb Mortal Wkly Rep. July 17 2009;58(27):749-752. breathing trials reduces ventilator and ICU days and further
• Noah MA, Peek GJ, Finney SJ, et al. Referral to an extra- improves survival.
corporeal membrane oxygenation center and mortality among
patients with severe 2009 influenza A(H1N1). JAMA. October 19,
2011;306(15):1659-1668. Epub 2011 Oct 5. In the past three decades, mortality from chronic obstructive pulmo-
1
• Peek GJ, Mugford M, Tiruvoipati R, et al; CESAR Trial Collaboration. nary disease (COPD) has risen dramatically, making chronic lower
respiratory disorders the third leading cause of death in the USA in
Efficacy and economic assessment of Conventional Ventilatory 2009. COPD was fifth internationally in 2002 and projected to be
2
Support Versus Extracorporeal Membrane Oxygenation for Severe the fourth leading cause of mortality by 2030. Compared with people
3
Adult Respiratory Failure (CESAR): a multicentre randomized with normal lung function, subjects with severe COPD (FEV <50%
controlled trial. Lancet. 2009;374(9698):1351-1363. predicted) followed for 22 years as part of the National Health and
1
• Pipeling MR, Fan E. Therapies for refractory hypoxemia in acute Nutrition Examination Survey (NHANES I) had a 2.7-fold increased
respiratory distress syndrome. JAMA. 2010;304:2521-2527. risk of death (95% confidence interval [CI] 2.1-3.5) in an adjusted
• Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after analysis. This trend is apparent in men and women, more prominent in
4
ECMO for severe acute respiratory failure: the Respiratory ECMO black Americans, and clearly related to cigarette smoking. More women
Survival Prediction (RESP)-Score. Am J Respir Crit Care Med. than men have died of COPD in the USA since 2000. Internationally
4,5
2014; Epub ahead PMID 24693864. COPD bears a significant morbidity and mortality burden accounting
for 27,700 disability adjusted life years (DALYs). Admissions to ICUs for
6
exacerbations of COPD account for a substantial portion of bed-days,
7
REFERENCES since these patients often require prolonged ventilatory support. Between
1998 and 2008 in the USA, there were an average of 765,067 (95% CI
Complete references available online at www.mhprofessional.com/hall 764,360-765,773) hospitalizations for acute exacerbation of COPD of

section04.indd 482 1/23/2015 2:20:04 PM