Successful use of esophageal pressure monitoring to evaluate spontaneously breathing during veno venous extracorporeal membrane oxygenation (VV-ECMO): a report of two cases

Abstract

Excessive spontaneous inspiratory efforts in veno venous extracorporeal membrane oxygenation (VV-ECMO) may exacerbate lung injury by generating elevated transpulmonary pressure. Case 1 was of a 25-years-old woman. VV-ECMO was initiated for severe acute respiratory distress syndrome (ARDS) with miliary tuberculosis. On day 6, end inspiratory transpulmonary pressure (EIP_L) was elevated to 24 cmH₂O after beginning awaking; after that, EIP_L was successfully reduced to 7 cmH₂O by continuous deep-sedation again. Case 2 was of a 51-years-old man. VV-ECMO was initiated for influenza-related ARDS with air leak syndrome. On day 4, EIP_L was maintained less than 20 cmH₂O after beginning awake ECMO; thus, spontaneously breathing was preserved. Considering that controlled efforts for spontaneous breathing by the two patients helped them recover from severe ARDS and air leak syndrome without lung injury, esophageal pressure monitoring during VV-ECMO is a good indicator to detect strong spontaneous effort and to decide whether to continue spontaneous breathing or not.