Refractory Hypoxemia: ECMO – Changes in the Exudative Phase (Nursing)

00:01 Then we can progress to something called ECMO.

00:04 Now, this is extracorporeal membrane oxygenation.

00:08 This is pretty cool stuff.

00:10 And this takes a highly trained nurse to monitor a patient and to organize this type of care.

00:16 It's only done in specialized ICU's.

00:19 Now, I live in a fairly big town, but we only have one hospital in the city that is available to do adult ECMO.

00:28 Now, we use ECMO for little tiny guys for like little premature babies.

00:33 We have those in the city, but having ECMO for adults is a whole another level.

00:39 So, keep in mind this isn't available everywhere and in every hospital.

00:43 It's got to be a very specialized ICU.

00:46 So a cannula is placed in a large blood vessel because it's job is to carry the patient's blood to a device, the ECMO that has a gas exchanging membrane.

00:56 Yes.

00:57 You heard me is this not so cool.

00:59 So we take blood out of the patient's body from a large vessel.

01:04 The ECMO delivers O2 to the blood and removes the CO2.

01:08 That's amazing.

01:10 It's like what the aveoli capillaries do but we do this outside of their body.

01:15 Then the blood is returned and it goes back into the patient's body.

01:19 Now, it's oxygenated and it's had the CO2 taken out or good to go.

01:24 This is a wonderful theory, but it is a very complicated procedure and it's not a great sign if your patient has declined to the point of needing ECMO.

01:34 But it is a fabulous thing, when it works and everything goes well.

01:39 Please keep in mind, lung damage is progressive in ARDS.

01:43 So I have it up here the three phases we've talked about, the exudative phase, the proliferative phase and the fibrotic phase.

01:52 Look at that you got, the days underneath like 0, 2, 7, 14 and 21.

01:57 Those are the days that things start happening.

02:00 So, see that hyaline membrane, you've got edema first that is definitely in the early phases.

02:05 Then the hyaline membrane start forming and you've got significant interstitial inflammation as you're in that proliferative phase.

02:13 then you can end up with fibrosis, which is long-term damage.

02:18 Okay, should you memorize? should you try? No, that's not what I want you to do, I want you to see.

02:23 that this is a progressive process.

02:26 We've given you three categories, phases, stages.

02:31 Whatever you want to call them, just to give you an idea of some milestones along the way.

02:38 Because I want to ask you a question.

02:39 Let's think back and take what you know about how oxygenation works in the lungs.

02:45 I don't want you to think about VQ mismatch.

02:48 Remember V stands for ventilation, Q stands for perfusion.

02:54 So what are the three most likely causes of the VQ mismatch in the exudative face? Okay, so think through.

03:02 What do you know happens in the exudative phase? What are the three things that are most likely to cause a ventilation or perfusion mismatch? Did you get it? Cool! The edema, the infiltrates and the possible collapse of the alveoli are the most likely causes of the VQ mismatch in the exudative face.