【体外膜肺ECMO精品课件】 Management of Infants requiring Venovenous ECMO.pptVIP

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2018-03-14 发布于天津
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【体外膜肺ECMO精品课件】 Management of Infants requiring Venovenous ECMO.ppt

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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Drainage Endhole High lateral RA Low lateral RA Infusion Mid Medial RA Optimal Cannula Placement Adequate size Correct depth Low Right Atrium Correct Rotation Label visible Drainage limb (Blue) posterior Infusion limb (Red) anterior Vertical orientation Head - midline No Kinks Recirculation Oxygenated ECMO blood returning to the ECMO circuit immediately after infusion Recirculation factors Head /cannula position Changes with head rotation Changes in lung volume / relative position of the heart and cannula ECMO flow Right atrial size / intravascular volume RV contractility ECMO Flow reads 200 ECMO blood flow to baby - 160 ECMO Flow reads 500 ECMO blood flow to baby - 250 ECMO Flow -Recirculation More ECMO flow will always increase recirculation More ECMO flow may either Increase blood flow to baby Decrease blood flow to baby VA ECMO ECMO flow rate is proportional to the level of support More flow More support Always advantageous if more flow is possible More ECMO flow will always increase SvO2 Pulmonary Support - VV Net ECMO blood flow of infant = measure ECMO flow - recirculation flow ECMO flow (flow probe) DOES NOT indicate level of support SvO2 DOES NOT reflect level of systemic oxygen delivery Circulatory Support Net flow to baby assessed by Infant color Infant arterial saturation and PaO2 Assessment of Recirculation More recirculation if Decreasing baby arterial sat or PaO2 Increasing SvO2 on ECMO circuit Decreasing color difference on drainage and infusion limbs of circuit Reducing Recirculation Adjusting relative cannula position Head position Lung inflation Decrease ECMO flow Increase intravascular volume Increase RV contractility Volume Vasopressors Pulmonary vasodilators VV - VA Conversion Needed if 10-15% of cases Hemodynamic support is inadequate Respiratory support is inadequate More problematic when ultrafiltration is used VV ECMO - Specific Is