Tania Tineo Drove
Hospital Universitario de La Princesa, SpainTitle: Veno-venous ECMO for the treatment of bronchopleural fistula in a patient undergoing pulmonary lobectomy
Abstract
Bronchopleural Fistula (BPF) is one of the complications derived from lung surgery, significantly increasing morbidity and mortality.The treatment depends on the complexity of the case, highlighting the use of extracorporeal respiratory assistance in the most serious cases.The implementation of ECMO (Venous-venous extracorporeal membrane oxygenation system) devices for the treatment of PBF constitutes the development of new lines of treatment for critically ill patients, since the strategy for the care of pulmonary abscesses associated with PBF, is aimed at treating: infection control, respiratory dysfunction and eliminating existing leakage.The objective of this type of treatment is based on the healing of the fistula and therefore the air leak, favoring an adequate exchange of gases at the same time that we can perform an ultraprotective ventilation. Professionals caring for patients with ECMO must be familiar with the use of these devices in order to ensure quality of care and patient safety.A fundamental pillar of the success of this type of therapy is teamwork between surgery, anesthesia, perfusion and critical care nursing.The implantation should be performed in centers with experience and capacity to resolve derived complications, since it is a highly complex therapy that must be established at the right time after exhausting the rest of the therapeutic options. The nursing team must be able to monitor and apply the care required by this type of patient, be able to detect possible complications and anticipate their care.Likewise, perfusionists must be 24 hours aware of the correct functioning of the ECMO, as well as the stability of the patient in all its spheres.The case of a patient who required the implantation of an ECMO VV as a recovery measure is presented. In this sense, we consider it necessary to develop protocols that allow standardizing clinical practice and improving the quality of care, because the use of this type of therapy is not without risks, highlighting those related to cannulation, the size of the cannulas, and the derivatives of the patient's anticoagulation and the consequent hemorrhagic complications.It is important to take into account the use of ECMO in patients in whom adequate oxygenation and ventilation pose a challenge for professionals. It is, nowadays, one of the steps of treatment of the FBP to achieve a ventilation that favors adequate healing through protective ventilation.
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