ARDS and ECMO, an update on critical care nursing


The acute respiratory distress syndrome (ARDS) is a very serious pathology caused by inflammation of the lung, usually infectious or traumatic. The alveoli are filled with inflammatory fluid, impairing gas exchange. Mechanical ventilation is the inevitable treatment, but it must ensure specific levels of alveolar pressure, tidal volume, and positive end-expiratory pressure (PEEP) not to exacerbate inflammation and ARDS. This is called protective ventilation but it does not always guarantee satisfactory blood gases, only the extra-corporeal membrane oxygenation (ECMO) can provide. Management of ARDS patient under ECMO is complex because it combines the care related to intensive care patient, very restrictive mechanical ventilation and ECMO. Intensive care nurse requires a very good knowledge of lung disease and respiratory assistance constraints, whether ventilatory or extra-corporeal.

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Courtin, A. , Sanchez, L. , Sinquet, J. , Gaudard, P. , Eliet, J. , Barge, F. and Colson, P. (2012) ARDS and ECMO, an update on critical care nursing. Open Journal of Nursing, 2, 301-306. doi: 10.4236/ojn.2012.223044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Bernard, G.R., Artigas, A., Brigham, K.L., Carlet, J., Falke, K., Hudson, L., Lamy, M., Legall, J.R., Morris, A. and Spragg, R. (1994) The American European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. American Journal of Respiratory and Critical Care Medicine, 149, 818- 824.
[2] Ware, L.B. and Matthay, M.A. (2000) The acute respiratory distress syndrome. The New England Journal of Medicine, 342, 1334-1349. doi:10.1056/NEJM200005043421806
[3] Brun-Buisson, C., Minelli, C., Brun-Buisson, C., Bertolini, G., Brazzi, L., Pimentel, J., Lewandoski, K., Bion, J., Romand, J.A., Villar, J., Thorsteinsson, A., Damas, P., Armaganidis, F. and the ALIVE Study group (2004) Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Medicine, 30, 51-56. doi:10.1007/s00134-003-2136-x
[4] Webb, H.H. and Tierney, D.F. (1974) Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. American Review of Respiratory Disease, 110, 556-565.
[5] Dirkes, S., Dickinson, S. and Valentine, J. (1992) Acute respiratory failure and ECMO. Critical Care Nurse, 12, 39-47.
[6] Combes, A., Bacchetta, M., Brodie, D., Müller, T. and Pellegrino, V. (2012) Extracorporeal membrane oxygenation for respiratory failure in adults. Current Opinion in Critical Care, 18, 99-104.
[7] Crimi, E. and Slutsky, A.S. (2002) Inflammation and the acute respiratory distress syndrome. Best Practice & Research Clinical Anaesthesiology, 18, 477-492 doi:10.1016/j.bpa.2003.12.007
[8] Herridge, M.S., Tansey, C.M., Matté, A., Tomlinson, G., Diaz-Granados, N., Cooper, A., Guest, C.B., Mazer, C.D., Mehta, S., Stewart, T.E., Kudlow, P., Cook, D., Slutsky, A.S. and Cheung, A.M. (2011) Functional disability 5 years after acute respiratory distress syndrome. The New England Journal of Medicine, 364, 1293-1304. doi:10.1056/NEJMoa1011802
[9] Brodie, D. and Bacchetta, M. (2011) Extracorporeal membrane oxygenation for ARDS in Adults. The New England Journal of Medicine, 365, 1905-1914. doi:10.1056/NEJMct1103720
[10] Papazian, L., Forel, J.-M., Gacouin, A., Penot-Ragon, C., Perrin, G., Loundou, A., Jaber, S., Arnal, J.-M., Perez, D., Seghboyan, J.-M., Constantin, J.-M., Courant, P., Lefrant, J.-Y., Guerin, C., Prat, G., Morange, S. and Roch, A. (2010) Neuromuscular blockers in early acute respiratory distress syndrome. The New England Journal of Medicine, 363, 1107-1116. doi:10.1056/NEJMoa1005372
[11] Boussarsar, M., Thierry, G., Jaber, S., Roudot-Thoraval, F., Lemaire, F. and Brochard, L. (2004) Relationship between ventilatory settings and barotrauma in the ARDS. Intensive Care Medicine, 28, 406-413. doi:10.1007/s00134-001-1178-1
[12] Dreyfuss, D. and Saumon, G. (1998) Ventilator-induced lung injury: Lessons from experimental studies. American Journal of Respiratory and Critical Care Medicine, 157, 294-323.
[13] Briel, M., Meade, M., Mercat, A., Brower, R.G., Talmor, D., Walter, S.D., Slutsky, A.S., Pullenayegum, E., Zhou, Q., Cook, D., Brochard, L., Richard, J.C., Lamontagne, F., Bhatnagar, N., Stewart, T.E. and Guyatt, G. (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome. Systematic review and Meta-analysis. Journal of the American Medical Association, 303, 865-873. doi:10.1001/jama.2010.218
[14] Amato, M.B.P., Barbas, C.S.V., Medeiros, D.M., Magaldi, R.B., Schettino, G.P.P., Lorenzi-Filho, G., Kairalla, R.A., Deheinzelin, D., Munoz, C., Oliveira, R., Takagaki, T.Y. and Carvalho, C.R.R. (1998) Effect of a protective ventilation strategy on mortality in the ARDS. The New England Journal of Medicine, 338, 347-354. doi:10.1056/NEJM199802053380602
[15] The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England Journal of Medicine, 342, 1301-1308.
[16] Peek, G.J., Mugford, M., Tiruvoipati, R., Wilson, A., Allen, E., Thalanany, M.M., Hibbert, C.L., Truesdale, A., Clemens, F., Cooper, N., Firmin, R.K. and Elbourne, D. (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial. Lancet, 374, 1351-1363. doi:10.1016/S0140-6736(09)61069-2
[17] The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. Journal of the American Medical Association, 302, 1888-1895. doi:10.1001/jama.2009.1535
[18] Kopp, R., Henzler, D., Dembinski, R. and Kuhlen, R. (2004) Extracorporeal membrane oxygenation by acute respiratory distress syndrome. Anaesthesist, 53, 168-174. doi:10.1007/s00101-003-0643-3
[19] ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1:1. Ann Arbor, April 2009.
[20] Maggiore, S.M., Lellouche, F., Pigeot, J., Taille, S., Deye, N., Durrmeyer, X., Richard, J.-C., Mancebo, J., Lemaire, F. and Brochard, L. (2003) Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. American Journal of Respiratory and Critical Care Medicine, 167, 1215-1224. doi:10.1164/rccm.200203-195OC

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