Manoli Iglesias, Phillipp Jungebluth, Purificacion Matute, Irene Rovira, Elisabeth Martinez, Carole Petit, Paolo Macchiarini; General Thoracic Surgical Experimental Laboratory, University of Barcelona, Barcelona, Spain
Objective: Investigate the feasibility and whether a pumpless extracorporeal lung membrane (PELM) (iLA, Novalung®, Hechingen, Germany) may improve the outcome of post-pneumonectomy non-cardiogenic acute respiratory distress syndrome (ppARDS) compared to conventional treatment in pigs.Methods: Twenty-five adults pigs randomly underwent a left thoracotomy either without further manipulation (sham group) or followed by a left extrapericardial pneumonectomy with radical lymphadenectomy; the latter were either observed (group 2) or received surfactant-depletion ARDS lavages of the remaining right lung followed by observation (group 3), treatment with a protective ventilation strategy, steroids and nitric oxide (group 4), or PELM support via an arterio-venous femoral cannulation (group 5). Each study group included 5 animals. Primary outcome was extubation 12 hours induction of ppARDS.
Results: Nine (±2) lung lavages delivered in 90±20 min developed a ppARDS (PaO2/FiO2, 82.7±8.6; pulmonary capillary wedge pressure [PCWP], 14.5±3.5 mm Hg; PaCO2, 61.2±10.7 mm Hg). The PELM device diverted 16.8±4.5% or 1.3±0.2 L/min of the cardiac output, and its average gas transfer was 530±181 mL/min O2 and 288±87 mL/min CO2. Mechanical ventilator settings after ppARDS in PELM were significantly lower (p<0.01) than standard treatment (tidal volume, 2.2±1 vs. 6±2 mL/kg; minute volume, 1±0,8 vs. 7.5±1 L/m; peak inspiratory pressure, 24.9± 2.5 vs. 33.8±6.4 mm Hg; RR, 6±2.9 vs. 19.5±0.8 breaths/min). An attenuation of the ppARDS lung cytokines release response (IL-6 and -8, and TNF-a) and recover of surfactant levels were observed in PELM-treated pigs (p< 0.01). Groups 3 and 4 pigs died from respiratory failure 3±1 and 10±2 hours after ppARDS induction, respectively. PELM was hemodynamically well tolerated and all but one group 5 pigs were extubated (p<0.01) (Table).
Conclusion: PELM support showed a significant better outcome than conventional treatment in ppARDS, most likely because the allowed static ventilation significantly attenuated the lung inflammatory response and re-established lung surfactant levels.
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