Iglesias Manuela, Jungebluth Philipp, Petit Carole, Matute María Purificación, Rovira Irene, Martínez Elisabeth, Catalan Miguel, Ramirez José, Macchiarini Paolo
General Thoracic Surgical Experimental Laboratory, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
J Thorac Cardiovasc Surg. 2008 Jun;135(6):1362-71. doi: 10.1016/j.jtcvs.2007.08.074.
We compared conventional treatment with pumpless extracorporeal lung membrane (Interventional Lung Assist [iLA] Novalung; Novalung GmbH, Hechingen, Germany) support in a pig model of postpneumonectomy severe acute respiratory distress syndrome.
Adult pigs underwent a left thoracotomy without (group I) or with a left extrapericardial pneumonectomy and radical lymphadenectomy (groups II to V). After stabilization, pigs belonging to group II were observed only, whereas in those belonging to groups III to V, a surfactant-depletion severe (Pao(2)/Fio(2) < 100) postpneumonectomy acute respiratory distress syndrome was induced. This was followed by observation (group III); treatment with conventional therapy including protective ventilation, steroids, and nitric oxide (group IV); or femoral arteriovenous iLA Novalung placement, near-static ventilation, steroids, and nitric oxide (group V). Each group included 5 animals. Primary outcome was extubation 12 hours postoperatively or postpneumonectomy acute respiratory distress syndrome.
A severe postpneumonectomy acute respiratory distress syndrome was obtained after 9 +/- 2 alveolar lavages over 90 +/- 20 minutes. In group V pigs, the iLA Novalung device diverted 17% +/- 4% of the cardiac output, permitted an oxygen transfer and carbon dioxide removal of 298.4 +/- 173.7 mL/min and 287.7 +/- 87.3 mL/min, respectively, and static ventilation (tidal volume, 2.2 +/- 1 mL/kg; respiratory rate, 6 +/- 2.9 breaths/min). All but 1 pig belonging to group V could be extubated compared with none in groups III and IV (P < .01), and only their lungs normalized cytokine release (P < .001) and surfactant (P < .03) and displayed fewer parenchymal lesions (P < .05).
The pumpless extracorporeal lung membrane and near-static ventilation achieved a significantly better outcome than conventional treatment in this pig model of severe postpneumonectomy acute respiratory distress syndrome, probably because the injured lungs were not forced to work and this "rest" gave them more time to heal.
在猪肺切除术后严重急性呼吸窘迫综合征模型中，我们比较了传统治疗与无泵体外肺膜（介入性肺辅助 [iLA] Novalung；德国赫钦根市诺瓦隆股份公司）支持治疗的效果。
成年猪接受左胸廓切开术，其中一组（I组）不进行肺切除术，其他组（II至V组）进行左心包外肺切除术及根治性淋巴结清扫术。稳定后，II组猪仅进行观察，而III至V组猪则诱导出表面活性剂耗竭型（动脉血氧分压/吸入氧分数值 [Pao(2)/Fio(2)] < 100）的肺切除术后急性呼吸窘迫综合征。之后，III组进行观察；IV组采用包括保护性通气、类固醇和一氧化氮在内的传统疗法进行治疗；V组则置入股动静脉iLA Novalung装置，采用近静态通气、类固醇和一氧化氮进行治疗。每组包括5只动物。主要结局指标为术后12小时拔管或肺切除术后急性呼吸窘迫综合征。
在90 ± 20分钟内进行9 ± 2次肺泡灌洗后，成功诱导出严重的肺切除术后急性呼吸窘迫综合征。V组猪中，iLA Novalung装置分流了17% ± 4%的心输出量，氧转运和二氧化碳清除量分别为298.4 ± 173.7 mL/分钟和287.7 ± 87.3 mL/分钟，并采用静态通气（潮气量，2.2 ± 1 mL/千克；呼吸频率，6 ± 2.9次/分钟）。与III组和IV组无一例拔管相比，V组除1只猪外均可拔管（P <.01），且只有V组猪的肺脏细胞因子释放（P <.001）和表面活性剂（P <.03）恢复正常，实质病变较少（P <.05）。
在该严重肺切除术后急性呼吸窘迫综合征猪模型中，无泵体外肺膜和近静态通气的治疗效果明显优于传统治疗，这可能是因为受伤的肺脏无需被迫工作，这种“休息”使其有更多时间愈合。
