Extracorporeal Life Support for Adults.
Schmidt, Gregory A.
Extracorporeal Life Support for Adults. - 1st ed. - 1 online resource (276 pages) - Respiratory Medicine Series . - Respiratory Medicine Series .
Intro -- Dedication -- Preface -- Contents -- Contributors -- Chapter 1: Physiology of Extracorporeal Life Support (ECLS) -- Introduction -- Cellular Metabolism -- Glycolysis and Aerobic and Anaerobic Metabolism -- Carbon Dioxide Production and the Respiratory Quotient -- Metabolism in the Stressed State -- Erythrocyte Metabolism -- Biophysics of Membrane Gas Exchange -- Membrane Oxygenator Construction -- Diffusion of Gas Molecules into a Liquid Phase -- Concentration of Gases in Solutions -- The Solubility of Respiratory Gases in Solution -- Biophysics of Membrane Oxygenation -- The Driving Force for Diffusive Transport of Gases -- Membrane Exposure Time -- Relative Flow Direction -- Effect of Turbulence and Haematocrit on Local Concentration Gradients -- Resistances to Diffusive Transport -- Area of the Gas Exchange Membrane -- Ultrafiltration of Plasma Water Over the Oxygenator Membrane [15] -- Oxygen Transport -- Oxygen Carriage -- Modulation of Haemoglobin's Affinity for Oxygen -- The Oxygen-Haemoglobin Dissociation Curve -- Mixing Blood of Differing Oxygen Partial Pressures -- Veno-venous ECMO and Oxygen Transport -- Arterial Saturations Are Dependent on the Fraction of Cardiac Output Captured -- Mixed Venous Saturations Are Determined by VO2 and Cardiac Output -- The Effect of Oxygen Carrying Capacity -- Modelling VV-ECMO -- Further Consideration of Recirculation -- The Importance of Mixed-Venous Saturation -- Venous Oxyhaemoglobin Saturation -- Limitations Imposed on VV-ECMO Oxygenation -- Carbon Dioxide Physiology -- Carbon Dioxide Transport in Physical Solution -- Reactions of Carbon Dioxide in Solution -- Effect of the Hydrogen Ion Concentration -- Carbonic Anhydrase -- The Arteriovenous-CO2 Difference and Carbamino Carriage -- Determinants of Carbon Dioxide Partial Pressure -- Extracorporeal Carbon Dioxide Removal: ECCO2R. Blood Flow Requirements -- Recirculation with Smaller Access Catheters -- Oxygenation in ECCO2R: Integration with Pulmonary Oxygenation -- Ventilation Strategies with ECCO2R -- ECCO2R and Alveolar Oxygen Concentrations -- Biophysics of the Extracorporeal Blood Path -- Types of Blood Pump -- Positive Displacement Pumps -- Velocity Pumps -- Centrifugal Constrained Vortex Pumps -- Axial Flow Pumps -- Monitoring Pump Output -- Physical Properties of Blood Relevant to Flow -- Viscoelasticity -- Flow of Ideal Fluids in Solid Conduits -- Resistance to Flow -- Resistance to Laminar Flow -- Turbulent Flow -- Reynolds Number -- Optimising Blood Flow for Gas Transfer -- The Oxygenator as a Resistor -- Conservation of Energy Across the ECLS Circuit -- Occlusion of the Flow Path -- Flow Regurgitation -- Cavitation -- Interaction of Velocity Pumps with the Systemic Circulation -- Ventricular Assist Devices: VADs -- VA-ECMO -- Flow Reversal -- Differential Cyanosis -- Valvular Incompetence -- Ventricular Preload vs. Device Preload -- Collapse Around the Inflow Cannula -- Mitral Inflow Restriction -- Right Ventricular (RV) Function and Pulmonary Haemodynamics -- Thrombus Formation -- Conclusions -- References -- Chapter 2: Hypoxemic Respiratory Failure: Evidence, Indications, and Exclusions -- Evidence -- Indications -- Exclusions -- References -- Chapter 3: Cardiogenic Shock: Evidence, Indications, and Exclusions -- Introduction -- Patient and Disease-Specific Issues -- Indication for VA-ECMO -- Configurations and Cannulation Strategies -- ECMO Retrieval Units -- ECMO in Specific Situations -- Acute Myocardial Infarction -- ECMO and Refractory Cardiac Arrest (ECPR) -- ECMO for Acute Myocarditis -- ECMO and Drug Intoxication -- ECMO Postcardiotomy -- ECMO and Heart Transplantation -- ECMO to Prevent Acute Right Ventricular Failure Following LVAD Implantation. ECMO and Profound Hypothermia -- ECMO and Massive Pulmonary Embolism -- ECMO for Refractory Septic Shock -- ECMO-Associated Complications -- Outcomes After VA-ECMO -- Conclusion -- References -- Chapter 4: ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions -- Introduction -- Evidence -- Indications -- Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) -- Acute Severe Asthma -- Exclusions -- References -- Chapter 5: ECLS as a Bridge to Lung Transplantation -- Introduction -- Historical Aspects -- Support Variations -- Interventional Lung Assist -- Venovenous ECLS -- Venoarterial ECLS -- Other Modes of Support -- Bridge to Lung Transplantation: General Considerations -- Pulmonary Failure -- Pulmonary Hypertension and Right Ventricular Failure -- Preventing Mechanical Ventilation with ECLS -- Other Indications for ECLS in Lung Transplantation -- Intraoperative VA-ECLS -- Postoperative ECLS -- ECLS for Organ Preservation -- Conclusions -- References -- Chapter 6: Modes of ECLS -- Introduction -- Venovenous ECLS -- The VV Circuit -- Physiological Implications of VV ECLS -- Advantages of VV ECLS -- Venoarterial ECLS -- The VA Circuit -- Physiological Implications of VA ECLS -- Advantages of VA ECLS -- Hybrid ECLS Configurations -- Veno-arterio-venous (VAV) ECLS -- AV Pumpless ECLS for CO2 Removal -- References -- Chapter 7: Vascular Access for ECLS -- Introduction -- Cannulas for Extracorporeal Support -- Single-Lumen Design -- Dual-Lumen Design -- Determinants of Cannula Blood Flow -- Patient Preparation -- Determination of Vessel Size -- Infection Control -- Insertion Technique -- Percutaneous -- Semi-open -- Open Surgical -- Cannulation Configurations -- Venoarterial -- Venovenous -- Veno-arterio-venous -- Low-Flow Venovenous -- Arteriovenous -- Transthoracic -- Decannulation -- Complications of Cannulation -- Recirculation. Insertion Site Bleeding -- Limb Ischemia -- Vascular Injury -- Inadequate Flow -- Infectious Complications -- References -- Chapter 8: Circuits, Membranes, and Pumps -- Introduction -- Circuit Anatomy -- Overall Circuit Considerations -- Circuit Priming -- Orientation to the Circuit -- Function of the Circuit Components -- Cannulas and Tubing -- Compliance Chamber -- Pumps -- Membrane Oxygenators -- Additional Limitations of Membrane Oxygenators -- Circuit Surface Coatings -- Heat Exchanger and Heater-Cooler -- References -- Chapter 9: Ventilator Management During ECLS -- Introduction -- Pathophysiology of Gas Exchange During ECLS -- Oxygenation -- Carbon Dioxide -- The Acute ARDS Phase: Controlled Mechanical Ventilation -- Walking the Tightrope Between Lung Recruitment and Lung Rest -- Specific Considerations About Venoarterial (VA) Mode -- Rescue Treatments for Persistent Hypoxemia During ECLS -- Prone Positioning -- Inhaled Pulmonary Vasodilators -- High-Frequency Oscillatory Ventilation (HFOV) -- Management of Pneumothoraces -- Assisted Ventilation During ECLS -- Avoiding Intubation by ECMO: Is It Possible? -- Disconnection from ECLS -- Partial Extracorporeal CO2 Removal (PECOR) and Ventilator Management -- Ventilatory Control During ECLS/PECOR -- Conclusions -- References -- Chapter 10: Daily Care on ECLS -- Introduction -- Circuit Housekeeping -- Phase I: Stabilization on ECLS -- Phase II: Stability on ECLS -- Lung Management -- Sedation: Brain, Nerves, Muscles, and Joints -- Heart -- Feeding and the Gastrointestinal Tract -- Kidneys -- Hematology, Anticoagulation, and Transfusion -- Phase III: Improvement -- Conclusion -- References -- Chapter 11: Crises During ECLS -- Introduction -- Circuit Crises -- Circuit Air -- Thrombosis -- Oxygenator Failure -- Pump Failure -- Tubing Rupture/Cannula Fracture -- Heat Exchanger. Inadvertent Decannulation -- Patient Crises -- Bleeding and Transfusions -- Hemolysis -- Refractory Hypoxemia -- Shock -- Conclusion -- References -- Chapter 12: Mobilization During ECLS -- Introduction -- Technological Advances -- The Health Costs of Immobility -- Early Mobilization Promotes Recovery -- Mobilization During ECLS -- Barriers to Mobilization During ECLS -- Mobilization: Team and Methods -- Conclusion -- References -- Chapter 13: ECMO Weaning and Decannulation -- Introduction -- Signs of Readiness -- ECMO Weaning and Liberation -- Ventilator Management -- Oxygenator Sweep Gas Flow Management -- ECMO Flow Management -- Anticoagulation Management -- Cardiopulmonary Assessment -- Decannulation -- Following Decannulation -- Termination of ECLS in Those Who Do Not Recover -- References -- Chapter 14: The Story of ECLS: History and Future -- Introduction -- Foundation for ECMO Development: Cardiopulmonary Bypass -- ECMO Technology: Direct Contact Oxygenators -- ECMO Technology: Silicone Rubber Membrane Lungs -- ECMO Technology: Microporous Devices -- ECMO Technology: Nonmicroporous Devices -- ECMO Configurations -- VA ECMO -- VV ECMO -- Extracorporeal Cardiopulmonary Resuscitation (ECPR) -- Clinical ECMO: Adult Respiratory Distress Syndrome -- Clinical ECMO Application: Neonatal Acute Respiratory Distress Syndrome -- Clinical ECMO Application: Pediatric Acute Respiratory Distress Syndrome -- Clinical ECMO Application: Bridge to Lung Transplantation -- Clinical ECMO Application: Supportive Technique Following Transplantation -- The ELSO Registry -- Conclusions -- References -- Index.
9781493930050
Internal medicine.
Electronic books.
RC705-779
615.8/362
Extracorporeal Life Support for Adults. - 1st ed. - 1 online resource (276 pages) - Respiratory Medicine Series . - Respiratory Medicine Series .
Intro -- Dedication -- Preface -- Contents -- Contributors -- Chapter 1: Physiology of Extracorporeal Life Support (ECLS) -- Introduction -- Cellular Metabolism -- Glycolysis and Aerobic and Anaerobic Metabolism -- Carbon Dioxide Production and the Respiratory Quotient -- Metabolism in the Stressed State -- Erythrocyte Metabolism -- Biophysics of Membrane Gas Exchange -- Membrane Oxygenator Construction -- Diffusion of Gas Molecules into a Liquid Phase -- Concentration of Gases in Solutions -- The Solubility of Respiratory Gases in Solution -- Biophysics of Membrane Oxygenation -- The Driving Force for Diffusive Transport of Gases -- Membrane Exposure Time -- Relative Flow Direction -- Effect of Turbulence and Haematocrit on Local Concentration Gradients -- Resistances to Diffusive Transport -- Area of the Gas Exchange Membrane -- Ultrafiltration of Plasma Water Over the Oxygenator Membrane [15] -- Oxygen Transport -- Oxygen Carriage -- Modulation of Haemoglobin's Affinity for Oxygen -- The Oxygen-Haemoglobin Dissociation Curve -- Mixing Blood of Differing Oxygen Partial Pressures -- Veno-venous ECMO and Oxygen Transport -- Arterial Saturations Are Dependent on the Fraction of Cardiac Output Captured -- Mixed Venous Saturations Are Determined by VO2 and Cardiac Output -- The Effect of Oxygen Carrying Capacity -- Modelling VV-ECMO -- Further Consideration of Recirculation -- The Importance of Mixed-Venous Saturation -- Venous Oxyhaemoglobin Saturation -- Limitations Imposed on VV-ECMO Oxygenation -- Carbon Dioxide Physiology -- Carbon Dioxide Transport in Physical Solution -- Reactions of Carbon Dioxide in Solution -- Effect of the Hydrogen Ion Concentration -- Carbonic Anhydrase -- The Arteriovenous-CO2 Difference and Carbamino Carriage -- Determinants of Carbon Dioxide Partial Pressure -- Extracorporeal Carbon Dioxide Removal: ECCO2R. Blood Flow Requirements -- Recirculation with Smaller Access Catheters -- Oxygenation in ECCO2R: Integration with Pulmonary Oxygenation -- Ventilation Strategies with ECCO2R -- ECCO2R and Alveolar Oxygen Concentrations -- Biophysics of the Extracorporeal Blood Path -- Types of Blood Pump -- Positive Displacement Pumps -- Velocity Pumps -- Centrifugal Constrained Vortex Pumps -- Axial Flow Pumps -- Monitoring Pump Output -- Physical Properties of Blood Relevant to Flow -- Viscoelasticity -- Flow of Ideal Fluids in Solid Conduits -- Resistance to Flow -- Resistance to Laminar Flow -- Turbulent Flow -- Reynolds Number -- Optimising Blood Flow for Gas Transfer -- The Oxygenator as a Resistor -- Conservation of Energy Across the ECLS Circuit -- Occlusion of the Flow Path -- Flow Regurgitation -- Cavitation -- Interaction of Velocity Pumps with the Systemic Circulation -- Ventricular Assist Devices: VADs -- VA-ECMO -- Flow Reversal -- Differential Cyanosis -- Valvular Incompetence -- Ventricular Preload vs. Device Preload -- Collapse Around the Inflow Cannula -- Mitral Inflow Restriction -- Right Ventricular (RV) Function and Pulmonary Haemodynamics -- Thrombus Formation -- Conclusions -- References -- Chapter 2: Hypoxemic Respiratory Failure: Evidence, Indications, and Exclusions -- Evidence -- Indications -- Exclusions -- References -- Chapter 3: Cardiogenic Shock: Evidence, Indications, and Exclusions -- Introduction -- Patient and Disease-Specific Issues -- Indication for VA-ECMO -- Configurations and Cannulation Strategies -- ECMO Retrieval Units -- ECMO in Specific Situations -- Acute Myocardial Infarction -- ECMO and Refractory Cardiac Arrest (ECPR) -- ECMO for Acute Myocarditis -- ECMO and Drug Intoxication -- ECMO Postcardiotomy -- ECMO and Heart Transplantation -- ECMO to Prevent Acute Right Ventricular Failure Following LVAD Implantation. ECMO and Profound Hypothermia -- ECMO and Massive Pulmonary Embolism -- ECMO for Refractory Septic Shock -- ECMO-Associated Complications -- Outcomes After VA-ECMO -- Conclusion -- References -- Chapter 4: ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions -- Introduction -- Evidence -- Indications -- Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) -- Acute Severe Asthma -- Exclusions -- References -- Chapter 5: ECLS as a Bridge to Lung Transplantation -- Introduction -- Historical Aspects -- Support Variations -- Interventional Lung Assist -- Venovenous ECLS -- Venoarterial ECLS -- Other Modes of Support -- Bridge to Lung Transplantation: General Considerations -- Pulmonary Failure -- Pulmonary Hypertension and Right Ventricular Failure -- Preventing Mechanical Ventilation with ECLS -- Other Indications for ECLS in Lung Transplantation -- Intraoperative VA-ECLS -- Postoperative ECLS -- ECLS for Organ Preservation -- Conclusions -- References -- Chapter 6: Modes of ECLS -- Introduction -- Venovenous ECLS -- The VV Circuit -- Physiological Implications of VV ECLS -- Advantages of VV ECLS -- Venoarterial ECLS -- The VA Circuit -- Physiological Implications of VA ECLS -- Advantages of VA ECLS -- Hybrid ECLS Configurations -- Veno-arterio-venous (VAV) ECLS -- AV Pumpless ECLS for CO2 Removal -- References -- Chapter 7: Vascular Access for ECLS -- Introduction -- Cannulas for Extracorporeal Support -- Single-Lumen Design -- Dual-Lumen Design -- Determinants of Cannula Blood Flow -- Patient Preparation -- Determination of Vessel Size -- Infection Control -- Insertion Technique -- Percutaneous -- Semi-open -- Open Surgical -- Cannulation Configurations -- Venoarterial -- Venovenous -- Veno-arterio-venous -- Low-Flow Venovenous -- Arteriovenous -- Transthoracic -- Decannulation -- Complications of Cannulation -- Recirculation. Insertion Site Bleeding -- Limb Ischemia -- Vascular Injury -- Inadequate Flow -- Infectious Complications -- References -- Chapter 8: Circuits, Membranes, and Pumps -- Introduction -- Circuit Anatomy -- Overall Circuit Considerations -- Circuit Priming -- Orientation to the Circuit -- Function of the Circuit Components -- Cannulas and Tubing -- Compliance Chamber -- Pumps -- Membrane Oxygenators -- Additional Limitations of Membrane Oxygenators -- Circuit Surface Coatings -- Heat Exchanger and Heater-Cooler -- References -- Chapter 9: Ventilator Management During ECLS -- Introduction -- Pathophysiology of Gas Exchange During ECLS -- Oxygenation -- Carbon Dioxide -- The Acute ARDS Phase: Controlled Mechanical Ventilation -- Walking the Tightrope Between Lung Recruitment and Lung Rest -- Specific Considerations About Venoarterial (VA) Mode -- Rescue Treatments for Persistent Hypoxemia During ECLS -- Prone Positioning -- Inhaled Pulmonary Vasodilators -- High-Frequency Oscillatory Ventilation (HFOV) -- Management of Pneumothoraces -- Assisted Ventilation During ECLS -- Avoiding Intubation by ECMO: Is It Possible? -- Disconnection from ECLS -- Partial Extracorporeal CO2 Removal (PECOR) and Ventilator Management -- Ventilatory Control During ECLS/PECOR -- Conclusions -- References -- Chapter 10: Daily Care on ECLS -- Introduction -- Circuit Housekeeping -- Phase I: Stabilization on ECLS -- Phase II: Stability on ECLS -- Lung Management -- Sedation: Brain, Nerves, Muscles, and Joints -- Heart -- Feeding and the Gastrointestinal Tract -- Kidneys -- Hematology, Anticoagulation, and Transfusion -- Phase III: Improvement -- Conclusion -- References -- Chapter 11: Crises During ECLS -- Introduction -- Circuit Crises -- Circuit Air -- Thrombosis -- Oxygenator Failure -- Pump Failure -- Tubing Rupture/Cannula Fracture -- Heat Exchanger. Inadvertent Decannulation -- Patient Crises -- Bleeding and Transfusions -- Hemolysis -- Refractory Hypoxemia -- Shock -- Conclusion -- References -- Chapter 12: Mobilization During ECLS -- Introduction -- Technological Advances -- The Health Costs of Immobility -- Early Mobilization Promotes Recovery -- Mobilization During ECLS -- Barriers to Mobilization During ECLS -- Mobilization: Team and Methods -- Conclusion -- References -- Chapter 13: ECMO Weaning and Decannulation -- Introduction -- Signs of Readiness -- ECMO Weaning and Liberation -- Ventilator Management -- Oxygenator Sweep Gas Flow Management -- ECMO Flow Management -- Anticoagulation Management -- Cardiopulmonary Assessment -- Decannulation -- Following Decannulation -- Termination of ECLS in Those Who Do Not Recover -- References -- Chapter 14: The Story of ECLS: History and Future -- Introduction -- Foundation for ECMO Development: Cardiopulmonary Bypass -- ECMO Technology: Direct Contact Oxygenators -- ECMO Technology: Silicone Rubber Membrane Lungs -- ECMO Technology: Microporous Devices -- ECMO Technology: Nonmicroporous Devices -- ECMO Configurations -- VA ECMO -- VV ECMO -- Extracorporeal Cardiopulmonary Resuscitation (ECPR) -- Clinical ECMO: Adult Respiratory Distress Syndrome -- Clinical ECMO Application: Neonatal Acute Respiratory Distress Syndrome -- Clinical ECMO Application: Pediatric Acute Respiratory Distress Syndrome -- Clinical ECMO Application: Bridge to Lung Transplantation -- Clinical ECMO Application: Supportive Technique Following Transplantation -- The ELSO Registry -- Conclusions -- References -- Index.
9781493930050
Internal medicine.
Electronic books.
RC705-779
615.8/362