Abstract
Objectives: Veno-venous extracorporeal membrane oxygenation (ECMO) is a well-established therapy in patients affected by respiratory failure and unresponsive to conventional therapy. Despite technical innovations, some limitations still exist, the most important one being refractory hypoxemia. This problem is linked partially to the mixture between patients' blood and ECMO fully oxygenated blood. In the present work, the reduction of cardiac output was proposed for the treatment of refractory hypoxemia in patients with high-flow ECMO and high endogenous cardiac output. Design: An observational study. Setting: A university hospital. Participants: Three consecutive patients suffering from persisting severe hypoxemia despite high-flow ECMO and with concomitant high cardiac output (>7 L/min). Intervention: A bolus dose of 500 μg/kg and a continuous infusion of esmolol was used and titrated to an SpO 2 >92%. Measurements and Main Results: Esmolol administration was safe and highly beneficial in terms of peripheral oxygenation. PaO 2 increased from 54 to 90 mmHg, from 50 to 94 mmHg, and from 49 to 66 mmHg during the first 12 hours of esmolol treatment in the 3 patients. Conclusions: In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion.
| Original language | English |
|---|---|
| Pages (from-to) | 58-63 |
| Number of pages | 6 |
| Journal | Journal of Cardiothoracic and Vascular Anesthesia |
| Volume | 26 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 2012 |
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Keywords
- β-blockers
- acute respiratory distress syndrome (ARDS)
- anesthesia
- esmolol
- extracorporeal membrane oxygenation (ECMO)
- intensive care
- refractory hypoxemia
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Anesthesiology and Pain Medicine
Cite this
β-blockers to optimize peripheral oxygenation during extracorporeal membrane oxygenation : A case series. / Guarracino, Fabio; Zangrillo, Alberto; Ruggeri, Laura; Pieri, Marina; Calabrò, Maria Grazia; Landoni, Giovanni; Stefani, Maurizio; Doroni, Luca; Pappalardo, Federico.
In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 26, No. 1, 02.2012, p. 58-63.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - β-blockers to optimize peripheral oxygenation during extracorporeal membrane oxygenation
T2 - A case series
AU - Guarracino, Fabio
AU - Zangrillo, Alberto
AU - Ruggeri, Laura
AU - Pieri, Marina
AU - Calabrò, Maria Grazia
AU - Landoni, Giovanni
AU - Stefani, Maurizio
AU - Doroni, Luca
AU - Pappalardo, Federico
PY - 2012/2
Y1 - 2012/2
N2 - Objectives: Veno-venous extracorporeal membrane oxygenation (ECMO) is a well-established therapy in patients affected by respiratory failure and unresponsive to conventional therapy. Despite technical innovations, some limitations still exist, the most important one being refractory hypoxemia. This problem is linked partially to the mixture between patients' blood and ECMO fully oxygenated blood. In the present work, the reduction of cardiac output was proposed for the treatment of refractory hypoxemia in patients with high-flow ECMO and high endogenous cardiac output. Design: An observational study. Setting: A university hospital. Participants: Three consecutive patients suffering from persisting severe hypoxemia despite high-flow ECMO and with concomitant high cardiac output (>7 L/min). Intervention: A bolus dose of 500 μg/kg and a continuous infusion of esmolol was used and titrated to an SpO 2 >92%. Measurements and Main Results: Esmolol administration was safe and highly beneficial in terms of peripheral oxygenation. PaO 2 increased from 54 to 90 mmHg, from 50 to 94 mmHg, and from 49 to 66 mmHg during the first 12 hours of esmolol treatment in the 3 patients. Conclusions: In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion.
AB - Objectives: Veno-venous extracorporeal membrane oxygenation (ECMO) is a well-established therapy in patients affected by respiratory failure and unresponsive to conventional therapy. Despite technical innovations, some limitations still exist, the most important one being refractory hypoxemia. This problem is linked partially to the mixture between patients' blood and ECMO fully oxygenated blood. In the present work, the reduction of cardiac output was proposed for the treatment of refractory hypoxemia in patients with high-flow ECMO and high endogenous cardiac output. Design: An observational study. Setting: A university hospital. Participants: Three consecutive patients suffering from persisting severe hypoxemia despite high-flow ECMO and with concomitant high cardiac output (>7 L/min). Intervention: A bolus dose of 500 μg/kg and a continuous infusion of esmolol was used and titrated to an SpO 2 >92%. Measurements and Main Results: Esmolol administration was safe and highly beneficial in terms of peripheral oxygenation. PaO 2 increased from 54 to 90 mmHg, from 50 to 94 mmHg, and from 49 to 66 mmHg during the first 12 hours of esmolol treatment in the 3 patients. Conclusions: In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion.
KW - β-blockers
KW - acute respiratory distress syndrome (ARDS)
KW - anesthesia
KW - esmolol
KW - extracorporeal membrane oxygenation (ECMO)
KW - intensive care
KW - refractory hypoxemia
UR - http://www.scopus.com/inward/record.url?scp=84855315083&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855315083&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2011.05.013
DO - 10.1053/j.jvca.2011.05.013
M3 - Article
C2 - 21764329
AN - SCOPUS:84855315083
VL - 26
SP - 58
EP - 63
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 1
ER -