A brief clinical case of monitoring of oxygenator

Authors: Mirko Belliato Antonella Degani Antonino Buffa Fabio Sciutti Michele Pagani Carlo Pellegrini Giorgio Antonio Iotti

Publish Date: 2016/08/24

Volume: 31, Issue: 5, Pages: 1027-1033

PDF Link

Abstract

Monitoring venovenous extracorporeal membrane oxygenation vvECMO during 76 days of continuous support in a 42years old patient with endstage pulmonary disease listed for doublelung transplantation Applying a new monitor Landing® Eurosets Medolla Italy and describing how measured and calculated parameters can be used to understand the variable interdependency between artificial membrane lung ML and patient native lung NL During vvECMO in order to understand how the respiratory function is shared between ML and NL ideally we should obtain data about oxygen transfer and CO2 removal both by ML and NL Measurements for NL can be made on the mechanical ventilator Measurements for ML are typically made from gas analysis on blood samples drawn from the ECMO system before and after the oxygenator and therefore are noncontinuous Differently the Landing monitor provides a continuous measurement of the oxygen transfer from the ML combined with hemoglobin level saturation of drained blood and saturation of reinfused blood Moreover the Landing monitor provides hemodynamics data about circulation through the ECMO system with blood flow preoxygenator pressure and postoxygenator pressure Of note measurements include the drain negative pressure whose monitoring may be particularly useful to prevent hemolysis Realtime monitoring of vvECMO provides data helpful to understand the complex picture of a patient with severely damaged lungs on one side and an artificial lung on the other side Data from vvECMO monitoring may help to adapt the settings of both mechanical ventilator and vvECMO Data about oxygen transfer by the oxygenator are important to evaluate the performance of the device and may help to avoid unnecessary replacements thus reducing risks and costs

Keywords: