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Review
. 2024 Apr 26;13(9):2541.
doi: 10.3390/jcm13092541.

Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation

Affiliations
Review

Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation

Rachele Simonte et al. J Clin Med. .

Abstract

Advanced respiratory monitoring encompasses a diverse range of mini- or noninvasive tools used to evaluate various aspects of respiratory function in patients experiencing acute respiratory failure, including those requiring extracorporeal membrane oxygenation (ECMO) support. Among these techniques, key modalities include esophageal pressure measurement (including derived pressures), lung and respiratory muscle ultrasounds, electrical impedance tomography, the monitoring of diaphragm electrical activity, and assessment of flow index. These tools play a critical role in assessing essential parameters such as lung recruitment and overdistention, lung aeration and morphology, ventilation/perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient-ventilator synchrony. In contrast to conventional methods, advanced respiratory monitoring offers a deeper understanding of pathological changes in lung aeration caused by underlying diseases. Moreover, it allows for meticulous tracking of responses to therapeutic interventions, aiding in the development of personalized respiratory support strategies aimed at preserving lung function and respiratory muscle integrity. The integration of advanced respiratory monitoring represents a significant advancement in the clinical management of acute respiratory failure. It serves as a cornerstone in scenarios where treatment strategies rely on tailored approaches, empowering clinicians to make informed decisions about intervention selection and adjustment. By enabling real-time assessment and modification of respiratory support, advanced monitoring not only optimizes care for patients with acute respiratory distress syndrome but also contributes to improved outcomes and enhanced patient safety.

Keywords: ECMO; acute respiratory failure; diaphragm ultrasound; electrical activity of the diaphragm; electrical impedance tomography; esophageal pressure; lung ultrasound; respiratory monitoring; transpulmonary pressure.

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Conflict of interest statement

Federico Longhini contributed to the development of a new helmet for mechanical ventilation, and he is designated as the inventor (European Patent number 3320941) not related to the present manuscript. He has also received speaking fees from Draeger, Intersurgical, and Fisher & Paykel. The remaining authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
Patients with acute respiratory failure necessitate different ventilatory supports (green boxes) according to disease severity. In these patients, several advanced respiratory monitoring techniques (light blue boxes) can be applied to assess and resolve several important issues (dark blue boxes). This approach aims to guarantee protective mechanical ventilation to the lung and respiratory muscles, tailored to the characteristics of every single patient (red boxes).
Figure 2
Figure 2
In patients with acute respiratory failure, even those receiving extracorporeal membrane oxygenation, advanced respiratory monitoring must be used including different tools like electrical impedance tomography, esophageal and transpulmonary pressures, lung and diaphragm ultrasonography, the electrical activity of the diaphragm, and flow index.
Figure 3
Figure 3
The steps required to achieve correct esophageal catheter positioning are summarized from left to right. In order to obtain reliable measures, all of the steps need to be strictly followed.

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