Chest
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Extracorporeal membrane oxygenation (ECMO) is a highly invasive therapy for intractable neonatal respiratory failure, and serious complications may occur with increasing duration of bypass. Weaning from bypass is empirical at present. Thus, there is a need to accurately predict when infants can be successfully decannulated. ⋯ Thus, a minimum Cdyn of 0.6 ml/cm H2O is associated with successful weaning from ECMO. Cdyn of 0.8 ml/cm H2O provided better overall discrimination between those who could be successfully weaned from ECMO. We conclude that serial measurement of dynamic pulmonary compliance predicts successful weaning from ECMO.
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The use of neuromuscular blocking agents, particularly pancuronium, in patients receiving mechanical ventilation has been reported to cause prolonged paralysis and atrophy. We describe two mechanically ventilated patients with asthma who developed prolonged muscular weakness and atrophy after receiving the shorter-acting agent vecuronium. These cases illustrate the potential of any neuromuscular blocking agent to cause these complications, especially in patients who are immobile, have decreased renal or liver function, or receive concomitant myotoxic agents.