Friday, December 28, 2007

ECMO (Extra Corporeal Membrane Oxygenation)


ECMO or extra corporeal membrane oxygenation is used when a child's lungs and/or heart are not able to perform their usual job. For whatever reason they are not able to do their work and the doctors caring for the child believe that ECMO can help, the ECMO machine provides support for the child allowing time for the lungs and/or heart to recover, repair, and develop for themselves. It works like a heart lung bypass machine similar to the one that is used in open heart surgery. Extra corporeal means "outside the body". The actual reality of the matter is this: it works like a heart and a lung for the child with a reversable heart or lungs disease. It can be used for a period of up to about two weeks.

A child would need ECMO for the following reasons:

1. Children with very severe lung disease not responding to the usual treatment of mechanical ventilation, medicines and extra oxygen.

These can include ARDS, pneumonia, trauma, asthma, aspiration, acute respiratory failure, auto immune disorders, oncology, sickle cell crisis or anything that can compromise the lungs.

2. Children who are waiting for heart or lung surgery and need the help of a bypass machine while they are waiting.ECMO works by circulating the unoxygenated blood from a vein in the neck into the artificial oxygenator (or artificial lung)where it gets rid of the carbon dioxide and receives oxygen. It is then put back into the body via an artery also in the neck. The child will also be on life support or a ventilator.

When a child is placed on ECMO, every effort is made to get them off as soon as possible. Each patient will be assigned a team of health care workers including Doctor, ECMO specialist, perfusionist, Respiratory Therapist, ECMO RN, and various other support people. When a child is placed on ECMO it is to save their life because nothing else has or will work. In other words, the child would die if it were not for the ECMO. A child will be placed on full support to start with. As healing begins to take place, settings will be turned down as the body is able to function better on it's own. The child's improvement is measured by blood samples, chest movement, improved chest x-rays and improved heart function. When this is seen, the ECMO flow will be gradually reduced to a stage where your child is actually taken off of ECMO for a short period of time. This time will be increased until the ECMO support is determined to no longer be needed. The child may still need full ventilator support. They may also need extra medications. Of course, all of this will be reduced as the child gets better.It is a very frightening thing to have your child placed on ECMO. As a parent, it is important to take care of yourself so that you are able to take care of your child when he or she gets better and will need you. It has been suggested that a parent keep a diary of all that goes on in order to know what questions to ask and to keep busy. This is a life and death situation. Gather your support people about you and allow yourself to use them.

ECMO-a last resort treatment that saves lives.

Tuesday, December 18, 2007

What is Empyema Thoracis?


Empyema thoracis is a very terrible illness. Empyema is actually pus. Thoracis is the chest. So by definition it is pus in the chest. However, empyema thoracis actually is pus in the space between the lungs and the chest wall known as the pleural cavity. Pus accumulates in the pleural space pushing against the lungs. As more and more pus is produced, the pus begins to push against the lungs making more difficult to breathe. The infection usually originates in the lungs and then spreads to the pleural space. A person usually has an underlying disease or infection before they develop empyema thoracis including pneumonia, lung cancer, chest wound, surgery, or bone cancer.

As many of you know, I am a Respiratory Therapist. One of my patients, who has multiple sclerosis also has developed empyema thoracis. The Pulmonologist put in a chest tube. The infection was so thick, that they also put in steptokinase to try to thin out the pus to drain it.

Although empyema thoracis signs and symptoms may vary, the most common ones are the following: Fever, coughing, weight loss, shortness of breath, chest pain, and fatigue. As it becomes a larger infection, the work of breathing increases and a person will need to be hospitalized to get help with their breathing and to have this infection drained. In more serious cases, surgery is required and a lobectomy may be necessary (partial lung removal).

When empyema thoracis becomes severe, the pus abscess can spread to other parts of the body and infect other organs. This can cause multi organ failure. Empyema thoracis is very important to get treated as soon as possible. As mentioned above treatments include chest tube, thorocentesis, surgery. Additionally, a very rigorous regime of antibiotics will be given.


Anytime the lungs are effected by an illness, it can become life threatening. It is very important to seek treatment early.

Friday, December 7, 2007

Is it the Common Cold or is it ARDS?


In a common cold a person catches a virus, it lasts for about two weeks or so. It is annoying and can involve sneezing, abundant mucous, and a sore throat. A person with a cold doesn't even have to see a doctor because it is a virus. People will urge you to take some vitamin C and zinc for to boost the immune system. All in all, it is annoying, but certainly not as serious as ARDS.

ARDS (Acute Respiratory Distress Syndrome or Adult Respiratory Distress Syndrome) occurs usually because of with widespread infection in the body (sepsis) or as a result of pneumonia, trauma, shock, severe burns, aspiration of food into the lung, multiple blood transfusions, and inhalation of toxic fumes, among other things. It usually develops within 24 to 48 hours after the original illness or injury and is considered a medical emergency. It may progress to involvement of other organs. When ever this happens, it can actually become life threatening. Symptoms which show that someone is going into ARDS is that they have difficulty breathing. The lungs become very stiff. It often is necessary to put someone like this on life support.

A chest x-ray of a set of normal lungs appear black (air appears black). The Chest x-ray of someone in ARDS often appears white. The lungs absorb fluid like sponges and become very stiff and difficult to ventilate. The difficulty of ventilation requires an internal medicine Doctor or Pulmonologist who isn't afraid to try different modes of ventilation.


A person with ARDS who needs to be put on life support will spend a minimum of two weeks on the ventilator. There is no medication that will heal the lungs from ARDS, it is a matter of waiting for the lungs to heal. Supportive therapy is all that can be done. Life support, antibiotics, sedation, diuretics and wait.

Whereas a cold is just that, a cold, which can be a pain, ARDS is a life threatening illness requiring life suport. The difference is that one can be life threatening and the other is just annoying.

Pneumothorax?


Contrary to popular belief, your lungs are not two balloons. They are more like a bunch of grapes. So when a person has a collapsed lung, it is usually not the whole lung, however, it can be any portion of the lung.

What is a Pneumothorax? A Pnuemothorax is air in the plural space surrounding the lung. This area should not contain air. When it does, the air pushes on the lung causing the little grapes or alveoli to collapse. This depending on the size causes the person to feel several things all at once. Shortness of breath, drop in oxygen saturation in the blood, and chest pain. Because the lung is not able to inflate like it should, oxygen cannot get into the blood stream like it should. Because of this, a pneumothorax is a potentially something that can be life threatening.


What causes a Pneumothorax? Usually, a pneumothorax is caused by some sort of injury to the chest wall. A broken rib that punctures the lung is an example. Another example is a stab wound. If a person does not have an injury to the chest wall but still somehow has a pnuemothorax, this is called a spontaneous pnuemthorax.

A spontaneous pnemothorax can be caused by several things. Tall thin people who smoke are among those who are at risk for a spontaneous pneumothorax. Also people who have lung disease such as cystic fibrosis, emphysema, asthma and pneumonia have a risk for a spontaneous pnumothorax.

How does a Pneumothorax get diagnoised? A chest x-ray is usually what is used to find the pneumothorax. Depending on the size, the pneumothorax is something that needs to be treated right away.

What is the treatment for a Pneumothorax? The doctor will put in a chest tube which will suck out the air in the pleural space allowing the lung to reinflate. This is almost immediate relief for a person having difficulting breathing. If the pneumothorax is a small one, the doctor will usually allow for it to resolve on it's own. However, this person will require observation to make sure that it doesn't worsen. Removal of the chest tube takes place when the xray shows healing and the chest tube is not draining so much.

A pneumothorax is a very serious matter and should never be taken lightly. When a person is short of breath and having chest pain, no matter the cause, they should be taken to ER for a chest xray.

We recommend: