Skip to main content

Advertisement

Log in

Lung ultrasound for the assessment of lung recruitment in neonates with massive pneumothorax during extracorporeal membrane oxygenation: a case report

  • Case Report
  • Artificial Lung / ECMO
  • Published:
Journal of Artificial Organs Aims and scope Submit manuscript

Abstract

Bedside lung ultrasound may be an effective method for the assessment of lung recruitment in newborns with extracorporeal membrane oxygenation (ECMO). We report a case of a neonate who had severe hypoxemia with persistent pulmonary hypertension and massive pneumothorax due to meconium aspiration syndrome and was treated with ECMO. Positive pressure mechanical ventilation resulted in persistent massive air leakage from the disrupted pulmonary tissue. When ECMO was initiated, a “total lung rest” ventilation strategy was used to facilitate healing of the lung rupture and absorption of the pneumothorax. After complete absorption of the pneumothorax, lung recruitment was performed by progressively increasing the positive end-expiratory pressure under the guidance of lung ultrasound. Bedside lung ultrasound was successfully used to assess pneumothorax absorption and improvement of pulmonary inflammation and successfully guided the recruitment of collapsed alveoli and the withdrawal of ECMO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fletcher K, Chapman R, Keene S. An overview of medical ECMO for neonates. Semin Perinatol. 2018;42:68–79. https://doi.org/10.1053/j.semperi.2017.12.002.

    Article  PubMed  Google Scholar 

  2. International Summary of ELSO Registry Report. 2020 Extracorporeal life support organization (ELSO). Ann Arbor, Michigan. Published by ELSO online at www.ELSO.org. https://www.elso.org/Registry/Statistics.aspx

  3. Shazia B, Arlene MS, Krisa PV, et al. Medical management of the neonate with respiratory failure on ECLS. In: Brogan TV, Lequier L, Lorusso R, et al., editors. Extracorporeal life support: the ELSO red book. 5th ed. Ann Arbor: Extracorporeal life support organization; 2017. p. 183–99.

    Google Scholar 

  4. Lu Q. How to assess positive end-expiratory pressure-induced alveolar recruitment? Minerva Anestesiol. 2013;79:83–91.

    CAS  PubMed  Google Scholar 

  5. Godet T, Constantin JM, Jaber S, et al. How to monitor a recruitment maneuver at the bedside. Curr Opin Crit Care. 2015;21:253–8. https://doi.org/10.1097/MCC.0000000000000195.

    Article  PubMed  Google Scholar 

  6. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–91. https://doi.org/10.1007/s00134-012-2513-4.

    Article  PubMed  Google Scholar 

  7. Tusman G, Acosta CM, Costantini M. Ultrasonography for the assessment of lung recruitment maneuvers. Crit Ultrasound J. 2016;8:8. https://doi.org/10.1186/s13089-016-0045-9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bartlett RH, Gazzaniga AB, Jefferies MR, et al. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs. 1976;22:80–93.

    CAS  PubMed  Google Scholar 

  9. Mahmood B, Newton D, Pallotto EK. Current trends in neonatal ECMO. Semin Perinatol. 2018;42:80–8. https://doi.org/10.1053/j.semperi.2017.12.003.

    Article  PubMed  Google Scholar 

  10. Short BL. Extracorporeal membrane oxygenation: use in meconium aspiration syndrome. J Perinatol. 2008;28:S79-83. https://doi.org/10.1038/jp.2008.152.

    Article  CAS  PubMed  Google Scholar 

  11. Keenan JC, Formenti P, Marini JJ. Lung recruitment in acute respiratory distress syndrome: what is the best strategy? Curr Opin Crit Care. 2014;20:63–8. https://doi.org/10.1097/MCC.0000000000000054.

    Article  PubMed  Google Scholar 

  12. Silva PL, Moraes L, Santos RS, et al. Recruitment maneuvers modulate epithelial and endothelial cell response according to acute lung injury etiology. Crit Care Med. 2013;41:e256–65. https://doi.org/10.1097/CCM.0b013e31828a3c13.

    Article  CAS  PubMed  Google Scholar 

  13. Hodgson C, Goligher EC, Young ME, et al. Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation. Cochrane Database Syst Rev. 2016;11:CD006667. https://doi.org/10.1002/14651858.CD006667.pub3.

    Article  PubMed  Google Scholar 

  14. Gattinoni L, Caironi P, Pelosi P, et al. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001;164:1701–11. https://doi.org/10.1164/ajrccm.164.9.2103121.

    Article  CAS  PubMed  Google Scholar 

  15. Jardin F. Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002;165:551. https://doi.org/10.1164/ajrccm.165.4.correspondenceia.

    Article  PubMed  Google Scholar 

  16. Lu Q, Rouby JJ. Measurement of pressure-volume curves in patients on mechanical ventilation: methods and significance. Minerva Anestesiol. 2000;66:367–75. https://doi.org/10.1186/cc662.

    Article  CAS  PubMed  Google Scholar 

  17. Lu Q, Constantin JM, Nieszkowska A, et al. Measurement of alveolar derecruitment in patients with acute lung injury: computerized tomography versus pressure-volume curve. Crit Care. 2006;10:R95. https://doi.org/10.1186/cc4956.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chiumello D, Mongodi S, Algieri I, et al. Assessment of lung aeration and recruitment by CT scan and ultrasound in acute respiratory distress syndrome patients. Crit Care Med. 2018;46:1761–8. https://doi.org/10.1097/CCM.0000000000003340.

    Article  PubMed  Google Scholar 

  19. Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183:341–7. https://doi.org/10.1164/ajrccm.185.4.457.

    Article  PubMed  Google Scholar 

  20. Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010;38:84–92. https://doi.org/10.1097/CCM.0b013e3181b08cdb.

    Article  PubMed  Google Scholar 

  21. Lu X, Arbelot C, Schreiber A, et al. Ultrasound assessment of lung aeration in subjects supported by venovenous extracorporeal membrane oxygenation. Respir Care. 2019;64:1478–87. https://doi.org/10.4187/respcare.06907.

    Article  PubMed  Google Scholar 

  22. Ntoumenopoulos G, Buscher H, Scott S. Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation. Int J Artif Organs. 2021;44:194–8. https://doi.org/10.1177/0391398820948870.

    Article  CAS  PubMed  Google Scholar 

  23. Mongodi S, Pozzi M, Orlando A, et al. Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience. Intensive Care Med. 2018;44:123–4. https://doi.org/10.1007/s00134-017-4941-7.

    Article  PubMed  Google Scholar 

  24. Jambrik Z, Monti S, Coppola V, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol. 2004;93:1265–70. https://doi.org/10.1016/j.amjcard.2004.02.012.

    Article  PubMed  Google Scholar 

  25. Chalumeau-Lemoine L, Baudel JL, Das V, et al. Results of short-term training of naïve physicians in focused general ultrasonography in an intensive-care unit. Intensive Care Med. 2009;35:1767–71. https://doi.org/10.1007/s00134-009-1531-3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are thankful for the cooperation of ECMO team, Chengdu women’s and children’s central hospital, Sichuan, China.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xiaolong Zhang.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this case were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient’s parents for the publication of this manuscript and any accompanying images.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Fu, Y., Yue, G. et al. Lung ultrasound for the assessment of lung recruitment in neonates with massive pneumothorax during extracorporeal membrane oxygenation: a case report. J Artif Organs 25, 163–169 (2022). https://doi.org/10.1007/s10047-021-01287-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10047-021-01287-z

Keywords

Navigation