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| Seventy-two Hours Total Respiratory Support with a Single Double-lumen Cannula Placed in a Venousvenous Pump-driven Extracorporeal Lung Membrane | |||||||||||||||||||||||||||||||||||||||||||||
David Sanchez-Lorente, Tetsuhiko Go, Philipp Jungebluth, Irene Rovira, Paolo Macchiarini; General Thoracic Surgical Experimental Laboratory, Universitat de Barcelona, Barcelona, Spain
Methods: Twelve pigs were initially ventilated for 2 hours (respiratory rate, 20-25 breaths/ min; tidal volume, 10-12 mL/ Kg; fraction of inspired oxygen, 1.0; positive end-expiratory pressure, 5 cm H2O). Thereafter, the extracorporeal lung membrane was attached to the right femoral (n= 6, 26F cannula) or jugular vein (n= 6, 22F cannula) using a single double-lumen cannula having one inflow venous and one outflow arterial channel. Ventilatory settings were then reduced to achieve near apneic ventilation (target settings: respiratory rate, 4 breath/ min; tidal volume, 1-2 mL/ Kg; fraction of inspired oxygen, 1.0; positive end-expiratory pressure, 10 cm H2O) and the pump flow increased hourly until maximal efficacy. Blood gases and hemodynamics were measured every hour and bronchial lavages and plasmatic cytokines level performed 4 hourly. Results: Mean blood flow through the device was 2.16 ± 0.43 L/ min, and permitted an O2 transfer and CO2 removal 203.6±54.6 and 590.3 ± 23.3 mL/ min, respectively. Despite static ventilation, all pigs showed optimal respiratory support during the study period, being the mean PaO2, PaCO2 and SvO2 226.2±56.4; 59.7±8.8 and 85.6± 5.3 mm Hg, respectively. There was no vasoactive drugs requirement to maintain hemodynamic stability (Table 1). Animals did not develop any significant changes regarding cytokine release or significant cellular trauma, and coagulatory and inflammatory response over the 72 hours. The route of cannulation (femoral vs. jugular) and the size of the cannulae did not changed hemodynamic or respiratory parameters significantly. Conclusion: The venousvenous, pump-driven extracorporeal lung membrane- single and double-lumen cannula system is an effective provider of total respiratory support over 72 hours and does not induce hemodynamic, coagulatory or inflammatory inbalances. Table 1. Pigs mechanical ventilatory and hemodynamic settings during initial ventilation (2hour) and apneic ventilation under extracorporeal support (72hours)
VT, volume tidal; RR, respiratory rate; MV, minute volume; CI, cardiac index; NS, not significant; MAP, mean arterial pressure; MPAP, mean pulmonary arterial pressure; SVR, systemic vascular resistance; PVR, pulmonary vascular resistance; PCWP, pulmonary capillary wedge pressure; CVP, central venous pressure. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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