Mechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure

OBJECTIVE To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure. DESIGN Descriptive study. SETTING A tertiary pediatric referral center. PATIENTS Children aged 1 month to 18 yrs treated with ECLS for acute respiratory failure at University of Michigan Hospitals from November 1982 to June 1993. All patients aged 1 month to 18 yrs who received ECLS for acute respiratory failure were included. Patients who received ECLS primarily for cardiac support or who had a diagnosis of congenital gastrointestinal malformation (i.e., congenital diaphragmatic hernia) were excluded. INTERVENTIONS ECLS for severe pediatric respiratory failure. MEASUREMENTS AND MAIN RESULTS Forty-nine children were treated at our center with ECLS for acute respiratory failure and 36 (73%) survived. Ventilator settings immediately after decannulation from ECLS for survivors were as followsFIO2 0.53 plus minus 0.18 (SD); intermittent mandatory ventilation (IMV) 29.6 plus minus 11.8 breaths/min, positive end-expiratory pressure 5.3 plus minus 1.6 cm H2 O, mean airway pressure 12.6 plus minus 2.9 cm H2 O, and peak inspiratory pressure 31.7 plus minus 5.5 cm H2 O. Arterial blood gas measurements at decannulation were PaO2 89.4 plus minus 30.9 torr (11.9 plus minus 4.1 kPa), PaCO2 43.7 plus minus 9.7 torr (5.8 plus minus 1.3 kPa), and pH 7.39 plus minus 0.07. Twenty-four hours after decannulation, ventilator settings and arterial blood gas measurements were as followsFIO2 0.42 plus minus 0.14, IMV 27.4 plus minus 13.5 breaths/min, positive end-expiratory pressure 5.2 plus minus 1.6 cm H2 O, mean airway pressure 12.0 plus minus 3.4 cm H2 O, peak inspiratory pressure 31.1 plus minus 6.5 cm H2 O, PaO2 77.0 plus minus 16.9 torr (10.3 plus minus 2.3 kPa), PaCO2 44.9 plus minus 8.4 torr (6.0 plus minus 1.1 kPa), and pH 7.40 plus minus 0.07. Variables associated with oxygenation status (P[A-a]o2) and mean airway pressure (oxygenation index) improved during the immediate 24-hr period postbypass (p less than .05). CONCLUSIONS Successful decannulation from ECLS for more than 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechani