Table 1.
Main respiratory setting, diagnostic, and therapeutical interventions relevant to the ventilation monitoring and management of the patient.
| ECMO day | E6 | E9 | E11 | E13 |
|---|---|---|---|---|
| Ventilation mode pre-FOT | AC/no VTG | AC/no VTG | AC/no VTG | AC+VTG |
| PIP (cmH2O) | 25 | 25 | 25 | 26 |
| PEEP pre-FOT (cmH2O) | 10 | 7 | 8 | 9 |
| PEEP post-FOT (cmH2O) | 7 | 8 | 9 | 9 |
| MAP (cmH2O) | 13 | 11 | 18 | 14 |
| RR set (bpm) | 16 | 15 | 25 | 38 |
| IT (sec.) | 0,6 | 0,6 | 0,6 | 0,45 |
| FiO2 | 0,4 | 0,60 | 0,40 | 0,40 |
| Vt effective (mL) | 1,6 - 4,8 | 5,30 | 8,70 | 15,00 |
| SpO2 pre-FOT (mean) | 94-95 | 96% | 95-96% | 95% |
| pH/pCO2/BE before | 7,32/58/+2 | 7,38/69,5/+6,4 | 7,34/49,5/+1.1 | 7,46/31/−0,8 |
| Blood flow/Sweep gas (ml/kg/min) | 150/150 | 150/200 | 60/100 | NA |
| FiO2 sweep gas (mean) | 0.5 | 0.5 | 0.5 | NA |
| Technical issues | Weaning | |||
| Chest X-ray | Bilateral patchy opacifications bilaterally severely hypodiaphan bilaterally hypodistended | Bilateral patchy opacifications + small right pleural effusion Bilaterally severely hypodiaphan Bilaterally hypodistended | Worsening patchy opacification in the right lung, stable pleural effusion Bilaterally normally distended | Same as E11 |
| Forced Oscillation Technique | Rigid and massively derecruited lung easily distended and not recruitable within the tested pressure range | Rigid lung recruitable within the tested pressure range | More compliant lung, derecruitment at the lowest peep tested | More compliant lung at all the explored PEEP |
| Relevant therapeutical interventions | SURF 200 mg/kg | E8: SURF (200 mg/kg) E9: BAL with SURF (73 mg/kg) E9: Start DEX 0.25mg/kg twice/d chest physiotherapy SLI, PEEP trial | E10: DEX 0.25mg/kg once/d E11:SURF 200mg/kg + DEX 0.125mg/kg twice/d chest physiotherapy SLI, PEEP trial | E12: DEX 0.125 mg/kg twice/d chest physiotherapy SLI, PEEP trial |
| Sedoanalgesia μg/kg/h | MOR 100 + MID 180 | MOR 100 + MID 180 | MOR 100 + MID 180 | MOR 100 + MID 180 |
| Extra bolus MOR/MDZ during FOT | 2/2 | 1/1 | 3/1 | 0/2 |
| Rocuronium mg/kg/die | 2,4 | 2,4 | 2,4 | 0 |
BAL, bronchoalveolar lavage; bpm, breath per minute; FiO2, fraction of inspired oxygen; IT, inspiratory time; MAP, mean airway pressure; MOR, morphine; MID, midazolam; PIP, peak inspiratory pressure; PEEP, positive end-expiratory pressure; SLI, sustained lung inflation; SURF, surfactant; DEX, dexamethasone; RR, respiratory rate; Vt, tidal volume.