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Biomedical subjects

G J Peek

Publications and source records attributed to G J Peek.

At least 19 recordsLinked to original sources
PubMed2005

Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO).

BACKGROUND: Conventional mechanical ventilation is the mainstay of treatment for severe respiratory failure associated with trauma. However, when extensive lung injury is present, this technique may not be sufficient to prevent hypoxia, and furthermore, may exacerbate pulmonary damage by barotrauma. Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill adult trauma patients and can offer an additional treatment modality. This study reports the use of ECMO in a cohort of adults referred with severe respiratory failure following trauma. METHODS: Retrospective analysis over an 8-year period of all 28 adult patients referred to a single tertiary unit for ECMO support. Survival relative to Injury severity score (ISS), lung injury score (Murray grade), duration of treatment and patient age was evaluated. RESULTS: Twenty of 28 patients who received ECMO with severe trauma related respiratory failure (mean PaO2/FiO2 of 62 mmHg) survived. Most patients had long bone fractures, blunt chest trauma, or combined injuries. Lung injury and injury severity scores, patient age, ECMO duration and oxygenation indices pre-ECMO (PaO2/FiO2) were similar in both the survivor and non-survivor groups. CONCLUSION: A high proportion of trauma patients treated with ECMO for severe lung injury survived. This outcome appears to compare favourably to conventional ventilation techniques and may have a role in patients who develop acute severe respiratory distress associated with trauma.

Accidents, Traffic↗
PubMed2003

Postoperative extracorporeal membrane oxygenation for severe intraoperative SIRS 10 h after multiple trauma.

A 34-yr-old male suffered multiple trauma in a road traffic accident. He required right thoracotomy and laparotomy to control exanguinating haemorrhage, and received 93 u blood and blood products. Intraoperatively, he developed severe systemic inflammatory response syndrome (SIRS) with coagulopathy and respiratory failure. At the end of the procedure, the mean arterial pressure (MAP) was 40 mm Hg, arterial blood gas analysis showed a pH of 6.9, Pa(CO(2)) 12 kPa, and Pa(O(2)) 4.5 kPa, and his core temperature was 29 degrees C. There was established disseminated intravascular coagulation. The decision was made to stabilize the patient on veno-venous extracorporeal membrane oxygenation (ECMO) only 10 h after the accident, in spite of the high risk of haemorrhage. The patient was stabilized within 60 min and transferred to the intensive care unit. He was weaned off ECMO after 51 h. He had no haemorrhagic complications, spent 3 weeks in the intensive care unit, and has made a good recovery.

Accidents, Traffic↗
PubMed2000

Modifying a venovenous extracorporeal membrane oxygenation circuit to reduce recirculation.

Lung rest is the primary goal of venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. To achieve this there has to be adequate extracorporeal flow. This can be achieved by a two-cannula technique in most cases. In some cases, extra flow is either not achievable or causes excessive recirculation. We report 8 patients in whom we achieved adequate blood and oxygen delivery using a three-cannula technique. Five patients survived (62.5%).

Acute Disease↗
PubMed2000

Spallation performance of extracorporeal membrane oxygenation tubing.

During the prolonged roller pump use of extracorporeal membrane oxygenation (ECMO), tubing wear generates spallation. The spallation performance of Tygon S-65-HL was measured and compared with a potential new ECMO tubing, LVA (Portex 800-500-575). Spallation was measured by on-line laser diode particle counting (HIAC) during simulated ECMO. The effects of differing levels of occlusion and pump speed were examined, as was the effect of spallation over time. The spallation produced by Tygon S-65-HL was less than that seen with LVA during 24 h of simulated ECMO (p < 0.001), and after 72 h had fallen almost to zero. Spallation with Tygon tubing increases with increasing pump speed and decreases over time. There appears to be only a weak correlation with occlusion, which is surprising. The spallation performance of Tygon S-65-HL was variable and under some conditions exceeded that of LVA. Overall, however, Tygon S-65-HL produced less spallation than LVA. Therefore, LVA cannot be recommended for clinical ECMO use.

Equipment Design↗
PubMed1999

Tubing failure during prolonged roller pump use: a laboratory study.

Little is known about the mechanical forces acting on extracorporeal circuit tubing with prolonged roller pump use during extracorporeal membrane oxygenation (ECMO). We examined the time to tubing rupture of three different materials during actual roller pump use, mean and standard deviation (SD) (SD shown in parentheses): Tygon (control) 243.7 h (175.4); LVA 121 h (14.3); and SRT 6.6 h (2.1). Failure times for both LVA and SRT were significantly different from the control (paired t-test, p = 0.02 and p < 0.001, respectively). The minimum failure times for Tygon and LVA were 99 and 101 h, respectively. We then examined Tygon under conditions of pure compression, demonstrating that even after 3.67 million compression cycles at full occlusion crack formation did not occur. If the tubing was over-occluded, cracks appeared within 24 h. Scanning electron microscopy of Tygon, which has been used during clinical ECMO, and the failure pattern during destruction testing demonstrate that shear stress and compression coexist during clinical ECMO. Use of under-occlusive pump settings could improve tubing life.

Equipment Failure Analysis↗
PubMed1998

Severe acute respiratory distress syndrome secondary to acute pancreatitis successfully treated with extracorporeal membrane oxygenation in three patients.

OBJECTIVE: To review three patients who underwent extracorporeal membrane oxygenation (ECMO) for acute respiratory failure secondary to pancreatitis. SUMMARY BACKGROUND DATA: Severe acute pancreatitis often causes the acute respiratory distress syndrome (ARDS), and if ventilation is required, the mortality rate is more than 50%. If the ratio of PaO2/FiO2 falls below 100 mm Hg or the Murray lung injury score exceeds 3.5, the mortality rate rises to more than 80%. Three patients who have severe ARDS secondary to pancreatitis, who were hypoxic despite ventilation with 100% oxygen and high airway pressures, and who were all successfully treated with ECMO are reported here. The consensus here is that all three patients would have died without ECMO. METHODS: Retrospective chart review and discussion of the literature. RESULTS: Pre-ECMO data: mean PaO2/FiO2 59.3 mm Hg, mean Murray lung injury score 3.7, one patient administered 20 ppm inhaled nitric oxide. ECMO data: mean extracorporeal flow at initiation of ECMO 56.3 mL/kg per minute, all patients administered veno-venous ECMO, mean duration of ECMO 104.7 hours. All patients were successfully weaned from ECMO and extubated. One patient had a protracted hospital stay because of a colo-cutaneous fistula. All patients are long-term survivors. CONCLUSIONS: Extracorporeal membrane oxygenation proved an effective therapy for severe ARDS complicating acute pancreatitis. Extracorporeal membrane oxygenation was conducted without bleeding complications in these three patients.

Acute Disease↗
PubMed1998

Extracorporeal membrane oxygenation: potential for adults and children?

Extracorporeal membrane oxygenation is a proven therapy for severe neonatal respiratory failure. Extracorporeal membrane oxygenation for older children and adults who are failing to respond to maximal conventional therapy is more controversial, but survival figures of 50-80% can be obtained, in patients with an expected survival of 0-20% with conventional treatment.

Adult↗
PubMed1997

Absorbable pulmonary artery band.

Absorbable pulmonary artery banding may be a useful method of avoiding further operation or angioplasty in patients whose underlying lesion has a natural history of resolution. We report 2 cases of absorbable pulmonary artery banding using braided Dexon. In both cases the bands functioned well initially and were completely resorbed after 2 years and 6 months, respectively.

Absorption↗
PubMed1997

Extra-corporeal membrane oxygenation for paediatric respiratory failure.

Extracorporeal membrane oxygenation (ECMO) uses modified cardiopulmonary bypass technology to provide prolonged respiratory or cardiorespiratory support for patients of all ages who have failed conventional intensive care management. The use of ECMO for neonatal respiratory failure is now evidence-based following the publication of the randomised UK Collaborative Trial. ECMO use in children remains more controversial, but overall survival of 71% is possible in a group of moribund patients whose mean PaO2/FIO2 ratio of 61 mmHg accurately predicts death in studies of conventional ventilation. Common diagnoses for children requiring ECMO support are pneumonia and the acute respiratory distress syndrome (ARDS).

Catheterization, Central Venous↗
PubMed1997

Extracorporeal membrane oxygenation for cardiac support.

Extracorporeal membrane oxygenation (ECMO) uses cardiopulmonary bypass technology to provide prolonged cardiac or respiratory support in the intensive care unit. The use of ECMO for neonatal respiratory failure is now good evidence-based medicine following publication of the UK Collaborative ECMO Trial, but its use in adults and children remains controversial. In this review the use of ECMO to support paediatric patients with pre- and post-operative cardiac insufficiency is discussed. The survival with ECMO in these patients is 43-61%, which is remarkable in a group of patients who are moribund prior to initiation of ECMO.

Adult↗
PubMed1997

Extracorporeal membrane oxygenation for adult respiratory failure.

OBJECTIVES: To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. DESIGN: Retrospective chart review. SETTING: Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center. PATIENTS: Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO2 to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressure, 39.6 (7.4) cm H2O; end-expiratory pressure, 10 (3.3) cm H2O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p=0.036 and p=0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p=0.036). CONCLUSIONS: Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.

Adult↗