Ventilation mécanique au cours de la prise en charge du syndrome de détresse respiratoire aigüe par circulation extracorporelle chez l'enfant

Abstract : Introduction: Acute respiratory distress syndrome (ARDS) is a common entity in pediatric intensive care and associated with a high mortality rate. When conventional management no longer ensures sufficient oxygenation, it is necessary to use extra-body circulatory assistance (ECMO). The objective of our study was to describe the mechanical ventilation parameters used when implementing extracorporeal circulatory support during the management of an ARDS in paediatrics. Materials and Methods: In a retrospective, mono-centric descriptive study, we included patients aged 0-18 years who had acute respiratory distress syndrome refractory to conventional mechanical ventilation management requiring extracorporeal ECMO assistance. Patients were included over the period 2007 to 2017. The main objective was to describe the mechanical ventilation parameters used during ECMO management. The secondary objective was to assess whether certain mechanical ventilation parameters could be associated with mortality in these patients. Results: 83 patients were included with a median age of 16 months[4 - 44 months], the mortality rate was 41%. Before implantation, 64% of patients received conventional ventilation and 36% by OHF. During the ECMO, the barometric ventilation mode was the most commonly used (73%). The median PEP was 10 cmH2O, the driving pressure was 16 cmH2O and the plateau pressures were less than 30 cmH2O. The comparison between deceased and living patients did not find any statistical difference in age or sex. The presence of immunosuppression was statistically associated with mortality, Odds Ratio 9.5 CI 95%[1.77 - 21.24], p = 0.002. The mean ventilation pressure at D7 of ECMO was significantly higher in the deceased group. Conclusions: Our results suggest that despite ECMO management, the mortality rate of pediatric ARDS remains high. To date, there are no recommendations for mechanical ventilation during the ECMO and it seems necessary to define them.
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Master Thesis
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Julien Jegard. Ventilation mécanique au cours de la prise en charge du syndrome de détresse respiratoire aigüe par circulation extracorporelle chez l'enfant. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02157749⟩

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