Boston - American Association for Thoracic Surgery

More documents

Recommendations

Info

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSF12. Seventy-Two Hours Total Respiratory Support with aSingle Double-Lumen Cannula Placed in a VenousvenousPump-Driven Extracorporeal Lung MembraneDavid Sanchez-Lorente, Tetsuhiko Go, Philipp Jungebluth, Irene Rovira,Paolo Macchiarini *General Thoracic Surgical Experimental Laboratory, Universitat de Barcelona,Barcelona, SpainInvited Discussant: Jay ZwischenbergerOBJECTIVE: To investigate the safety and feasibility of obtaining total respiratorysupport during 72 hours using a pump-driven (Levitronix Centrimag ® centrifugalpump) venousvenous extracorporeal lung membrane (Novalung GmbH, Hechingen,Germany) attached via a single double-lumen cannula (Novalung GmbH)into the femoral or jugular vein in adult pigs.METHODS: Twelve pigs were initially ventilated for 2 hours (respiratory rate, 20–25breaths/min; tidal volume, 10–12 mL/Kg; fraction of inspired oxygen, 1.0; positiveend-expiratory pressure, 5 cm H 2 O). Thereafter, the extracorporeal lung membranewas attached to the right femoral (n = 6, 26 F cannula) or jugular vein (n = 6,22F cannula) using a single double-lumen cannula having one inflow venous andone outflow arterial channel. Ventilatory settings were then reduced to achievenear 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 H 2 O) and the pump flow increased hourly until maximal efficacy. Bloodgases and hemodynamics were measured every hour and bronchial lavages andplasmatic cytokines level performed 4 hourly.RESULTS: Mean blood flow through the device was 2.16 ± 0.43 L/min, and permittedan 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 supportduring the study period, being the mean PaO2, PaCO2 and SvO2 226.2 ± 56.4; 59.7± 8.8 and 85.6 ± 5.3 mmHg, respectively. There was no vasoactive drugs requirementto maintain hemodynamic stability (Table 1). Animals did not develop anysignificant changes regarding cytokine release or significant cellular trauma, andcoagulatory and inflammatory response over the 72 hours. The route of cannulation(femoral vs. jugular) and the size of the cannulae did not changed hemodynamicor respiratory parameters significantly.* AATS Member140
AMERICAN ASSOCIATION FOR THORACIC SURGERYTable 1. Pigs Mechanical Ventilatory and Hemodynamic Settings During InitialVentilation (2 Hour) and Apneic Ventilation Under Extracorporeal Support(72 Hours)VariablesInitial Ventilationwithout ExtracorporealSupportApneic Ventilationwith ExtracorporealSupportp-ValueVT (ml) 537 ± 68 115 ± 13 p < 0.05RR(breaths/min) 20 ± 0 4 ± 0 p < 0.05MV (L/min) 10.7± 1.4 0.4 ± 0.05 p < 0.05CI (L/min/m2) 4.8 ± 0.6 5.1 ± 0.9 NSMAP (mmHg) 113 ± 9.9 95.4 ± 12.6 NSMPAP (mmHg) 24 ± 5.7 34.4 ± 3.1 NSSVR (dyne/cm5) 872 ± 252.4 1073± 273.2 NSPVR (dyne/cm5) 120.8 ± 14.3 188 ± 40.6 NSPCWP (mmHg) 15.3 ± 1.75 16.9 ± 2.4 NSCVP (mmHg) 11.5 ± 2.3 12.4 ± 2.5 NSVT, 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 vascularresistance; PVR, pulmonary vascular resistance; PCWP, pulmonary capillary wedge pressure;CVP, central venous pressure.TUESDAYMorningCONCLUSION: The venousvenous, pump-driven extracorporeal lung membranesingleand double-lumen cannula system is an effective provider of total respiratorysupport over 72 hours and does not induce hemodynamic, coagulatory or inflammatoryinbalances.141
Page 1 and 2:
American Associationfor Thoracic Su
Page 3 and 4:
AMERICAN ASSOCIATION FOR THORACIC S
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92: AMERICAN ASSOCIATION FOR THORACIC S
Page 141: AMERICAN ASSOCIATION FOR THORACIC S
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 227 and 228:
AATS FUTURE MEETINGSMay 1-5, 2010Me
show all

Boston - American Association for Thoracic Surgery

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?