Jungebluth Philipp, Iglesias Manuela, Go Tetsuhiko, Sibila Oriol, Macchiarini Paolo
General Thoracic Surgical Experimental Laboratory, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Artif Organs. 2008 Nov;32(11):885-90. doi: 10.1111/j.1525-1594.2008.00646.x.
The aim of this study was to determine the optimal positive end-expiratory pressure (PEEP) required during extracorporeal lung membrane support (interventional lung assist [iLA]; Novalung GmbH, Hechingen, Germany). Twenty healthy pigs were initially (4 h) mechanically ventilated with a tidal volume (V(T)) of 10 mL/Kg, respiratory rate (RR) of 20 breaths/min, PEEP of 5 cm H(2)O, and fraction of inspired O(2) (FiO(2)) of 1.0. Thereafter, the iLAs were placed arteriovenously transfemorally and settings reduced to reach near static ventilation (V(T) < or = 2 mL/Kg, RR 4 breaths/min, PEEP of 5, FiO(2) 1.0). Then, animals were assigned to four study groups evaluating 5 cm H(2)O increasing levels of PEEP for 8 h. Gas exchanges with PEEP < or = 10 cm H(2)O were significantly worse than those with PEEP > 12 cm H(2)O, and this without hemodynamical imbalance. This study suggests that the iLA may provide adequate gas exchange during static ventilation only with PEEP levels > 10 cm H(2)O, and this without pulmonary or systemic hemodynamic imbalance.
本研究的目的是确定体外肺膜支持（介入性肺辅助[iLA]；德国黑兴根市Novalung有限公司）期间所需的最佳呼气末正压（PEEP）。20只健康猪最初（4小时）以潮气量（V(T)）10 mL/Kg、呼吸频率（RR）20次/分钟、PEEP 5 cm H₂O和吸入氧分数（FiO₂）1.0进行机械通气。此后，经股动静脉置入iLA，并降低设置以达到接近静态通气（V(T)≤2 mL/Kg、RR 4次/分钟、PEEP 5、FiO₂ 1.0）。然后，将动物分为四个研究组，评估5 cm H₂O逐渐增加的PEEP水平，持续8小时。PEEP≤10 cm H₂O时的气体交换明显比PEEP>12 cm H₂O时差，且无血流动力学失衡。本研究表明，iLA仅在PEEP水平>10 cm H₂O时才能在静态通气期间提供足够的气体交换，且无肺或全身血流动力学失衡。
