Nielsen Niels D, Kjaergaard Benedict, Koefoed-Nielsen Jacob, Steensen Christian O, Larsson Anders
Anaesthesia Research Unit, Anaesthesia and Intensive Care Medicine, North Denmark Region, Aarhus University Hospital, Aalborg, Denmark.
ASAIO J. 2008 Jul-Aug;54(4):401-5. doi: 10.1097/MAT.0b013e31817e2b5f.
We hypothesized that apneic oxygenation, using an open lung approach, combined with extracorporeal CO2 removal, would provide adequate gas exchange in acute lung injury. We tested this hypothesis in nine anesthetized and mechanically ventilated pigs (85-95 kg), in which surfactant was depleted from the lungs by repeated lung lavage. After a lung recruitment maneuver, the tracheal tube was connected to 20 cm H2O continuous pressure (100% O2) for oxygenation of the blood. A pumpless membrane ventilator (interventional lung assist by Novalung) was connected in an arteriovenous shunt for CO2 removal. PaO2 and PaCO2 were recorded for 3.5 hours. PaO2 was 464 (403, 502) mm Hg (median and interquartile range) throughout the experiment. The O2 uptake through the lungs was 185 (164, 212) ml/min. PaCO2 increased asymptotic towards 60 mm Hg. The CO2 removal through the membrane ventilator was 180 (150, 180) ml/min. Thus, the method provided adequate gas exchange in this experimental model, suggesting that it might have potential as an alternative treatment modality in acute lung injury.
我们假设，采用开放肺策略的无呼吸氧合结合体外二氧化碳清除，能够在急性肺损伤中提供充足的气体交换。我们在9只麻醉并机械通气的猪（85 - 95千克）身上验证了这一假设，这些猪的肺通过反复灌洗使其表面活性物质耗竭。在进行肺复张操作后，气管导管连接至20厘米水柱的持续压力（100%氧气）以实现血液氧合。一台无泵膜式通气机（Novalung公司的介入性肺辅助设备）连接在动静脉分流处以清除二氧化碳。记录3.5小时内的动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。在整个实验过程中，PaO2为464（403，502）毫米汞柱（中位数和四分位间距）。通过肺摄取的氧气量为185（164，212）毫升/分钟。PaCO2逐渐升高并趋近于60毫米汞柱。通过膜式通气机清除的二氧化碳量为180（150，180）毫升/分钟。因此，该方法在这个实验模型中提供了充足的气体交换，表明它可能具有作为急性肺损伤替代治疗方式的潜力。
