Sage Journals: Discover world-class research

Abstract

This prospective large-animal study was performed to evaluate the contribution of arterio-venous extracorporeal lung assist (AV-ECLA) to pulmonary gas exchange in a porcine lavage-induced acute lung injury model. Fifteen healthy female pigs, weighing 50.39±3.8 kg (mean±SD), were included.

After induction of general anaesthesia and controlled ventilation, an arterial line and a pulmonary artery catheter were inserted. Saline lung lavage was performed until the PaO₂ decreased to 51±16 mmHg. After a stabilization period of 60 min, the femoral artery and vein were cannulated and a low-resistance membrane lung was interposed. Under apnoeic oxygenation, variations of sweep-gas flow were performed every 20 min in order to evaluate the membrane lung's efficacy, in terms of carbon dioxide (CO₂) removal and oxygen (O₂) uptake. Although AV-ECLA is highly effective in eliminating CO₂, if combined with apnoeic oxygenation, normocapnia was not achievable. AV-ECLA's contribution to oxygenation during severe hypoxemia was antagonized by a significant increase in the pulmonary shunt fraction.

Get full access to this article

View all access options for this article.

References

Morris AH , Wallace CJ , Menlove RL , Clemmet TP , Onme JF , Weaver LK , Dean VC , Thomas F , East TB , Pace NL . Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome . Am J Respir Crit Care Med 1994; 149: 295-305 .

Zapol WM , Snider MT , Hill JD , Fallat RJ , Bartlett RH , Edmunds LH , Morris AH , Peirce EC , Thomas AN , Proctor HJ , Drinker PA , Pratt PC , Bagmiewski A , Miller RG . Extracorporeal membrane oxygenation in severe acute respiratory failure . A randomized prospective study. JAMA 1979; 242: 2193-2196 .

Rashkind W , Freeman A , Klein D , Toft R . Evaluation of a disposable plastic, low volume, pumpless oxygenator as a lung substitute . J Pediatr 1965; 66: 94-102 .

Grubitzsch H , Beholz S , Wollert HG , Eckel L . Pumpless arteriovenous extracorporeal lung assist: what is its role? Perfusion 2000; 15: 237-242 .

Tao W , Brunston RL Jr. , Bidani A , Pirtle P , Dy J , Cardenas VJ , Fraser DL , Zwischenberger J . Significant reduction in minute ventilation and peak inspiratory pressures with arteriovenous CO2 removal during severe respiratory failure . Crit Care Med 1997; 25: 689-695 .

Brunston RL Jr. , Tao W , Bidani A , Alpard SK , Fraber DL , Zwischemberger JB . Prolonged hemodynamic stability during arteriovenous carbon dioxide removal for severe respiratory failure . J Thorac Cardiovasc Surg 1997; 114: 1107-1114 .

Sussmane JB , Totapally BR , Hultquist K , Torbati D , Wolfsdorf J . Effects of arteriovenous extracorporeal therapy on hemodynamic stability, ventilation, and oxygenation in normal lambs . Crit Care Med 2001; 29: 1972-1978 .

Reng M , Philipp A , Kaiser M , Pfeifer M , Gruene S , Schoelimerich J . Pumpless extracorporeal lung assist and adult respiratory distress syndrome . Lancet 2000; 356: 219-220 .

Brederlau J , Anetseder M , Wagner R , Roesner T , Philipp A , Greim C , Roewer N . Pumpless extracorporeal lung assist in severe blunt chest trauma . J Cardiothorac Vasc Anesth 2004; 18: 777-779 .

10.

Gattinoni L , Kolobow T , Tomlinson T , Lapichino G , Samaja M , White D , Pierce J . Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPV-ECCO2R): an experimental study . Anesth Analg 1978; 57: 470-477 .

11.

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network . N Engl J Med 2000; 342: 1301-1308 .

12.

Lang JD , Figueroa M , Sanders KD , Aslam M , Liu Y , Chumley P , Freeman BA . Hypercapnia via reduced rate and tidal volume contributes to lipopolysaccharideinduced lung injury . Am J Respir Crit Care Med 2005; 171: 147-157 .

13.

Hickling KG , Walsh J , Henderson S , Jackson R . Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study . Crit Care Med 1994; 22: 1568-1578 .

14.

Bein T , Scherer MN , Philipp A , Weber F , Woertgen C . Pumpless extracorporeal lung assist (pECLA) in patients with acute respiratory distress syndrome and severe brain injury . J Trauma 2005; 58: 1294-1297 .

15.

Domino KB , Wetstein L , Glasser SA , Lindgoem L , Marshall C , Harken A , Marshall BE . Influence of mixed venous oxygen tension (PVO2) on blood flow to atelectatic lung . Anesthesiology 1983; 59: 428-434 .

16.

Sandoval J , Long GR , Skoog C , Wood LD , Oppenheimer L . Independent influence of blood flow rate and mixed venous PO2 on shunt fraction . J Appl Physiol 1983; 55: 1128-1133 .

17.

Lachmann B . Open up the lung and keep the lung open . Intensive Care Med 1992; 18: 319-321 .

18.

Kloot TE , Blanch L , Melgynne Youngblood A , Weinert C , Adams AB , Manini JJ , Slapino RS , Nalum A . Recruitment maneuvers in three experimental models of acute lung injury. Effect on lung volume and gas exchange . Am J Respir Crit Care Med 2000; 161: 1485-1494 .

19.

Imai Y , Parodo J , Kajikawa O , de Pennot M , Fischer S , Edward V , Cutz E , Liu M , Keshaujee S , Martin TR , Marshall JC , Rauieni VR , Slutsky AS . Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome . JAMA 2003; 289: 2104-2112 .

The contribution of arterio-venous extracorporeal lung assist to gas exchange in a porcine model of lavage-induced acute lung injury

Abstract

Get full access to this article

References