Prone during pandemic: development and implementation of a quality-based protocol for proning severe COVID-19 hypoxic lung failure patients in situationally or historically low resource hospitals.

Background: Intermittent Prone Positioning (IPP) for Acute Respiratory Distress Syndrome (ARDS) decreases mortality. We present a program for IPP using expedient materials for settings of significant limitations in both overwhelmed established ICUs and particularly in low- and middle-income countries (LMICs) treating ARDS due to COVID-19 caused by SARS CoV-2.

Methods: The proning program evolved based on the principles of High Reliability Organizations (HROs) and Crew Resource Management (CRM).

Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients.

Methods: In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality.

Use of HFPV for adults with ARDS: the protocolized use of high-frequency percussive ventilation for adults with acute respiratory failure treated with extracorporeal membrane oxygenation.

Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV.

Extracorporeal membrane oxygenation can provide cardiopulmonary support during bronchoscopic clearance of airways after sand aspiration.

Background: Sand aspiration occurs in situations of cave-in burial and near-drowning. Sand in the tracheobronchial airways adheres to the mucosa and can cause tracheal and bronchial obstruction, which can be life-threatening even with intensive management. In previous case reports of airway obstruction caused by sand aspiration, fiber optic or rigid bronchoscopy has been effective in removing loose sand, but removal of sand particles lodged in smaller airways has proven challenging and time-consuming.

Pandemic flu and the sudden demand for ECMO resources: a mature trauma program can provide surge capacity in acute critical care crises.

Background: Patients with severe H1N1 pneumonia created a sudden demand for extracorporeal membrane oxygenation (ECMO) capacity. In a single referral center, the established procedures, protocols, and staff of the Level I trauma service were adapted to help manage this nontrauma critical care crisis.

Methods: When airway pressure release ventilation and high-frequency oscillator ventilation failed, we used standard ECMO circuits and the VDR-4 critical care ventilator.

Reducing time on for extra-corporeal membrane oxygenation for adults with H1N1 pneumonia with the use of the Volume Diffusive Respirator.

Background: The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO.

Methods: Adults who survived ECMO were compared regarding time on ECMO for those treated with the Volume Diffusive Respirator (VDR) or with conventional "lung rest." The VDR delivered 500 percussions/min, with tidal pressures of 24/12 cm H2O and a fraction of inspired oxygen of .

Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: the role of a regional referral center.

Background: The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center.

Methods: Patients with refractory hypoxic ARDS received ECMO until they recovered lung function or demonstrated futility. ECMO was initiated at the referring facility if necessary, and aggressive critical care was maintained throughout.

Management of post traumatic respiratory failure.

Acute respiratory distress syndrome (ARDS) is a severe and common complication of major trauma. The most important early management principle is to identify the inciting event and remove the ongoing insult aggressively. It is important to immediately resuscitate the patients and prepare them for a complex and difficult hospitalization.

A protocolized approach to pulmonary failure and the role of intermittent prone positioning.

Introduction: We present a series of adult patients treated under a protocol for severe lung failure (acute respiratory distress syndrome [ARDS]) that uses positive end-expiratory pressure (PEEP) optimization and intermittent prone positioning (IPP) to reduce shunt, improve oxygen (O(2)) delivery, and reduce FiO(2).

Methods: Trauma, emergency vascular, and general surgical patients with PaO(2)/FiO)(2) (PF) ratio < 200 were entered into a protocol designed to maintain mixed venous saturation (SVO(2)) > 70% with FiO(2) < 0.50.