Müller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede C E, Zimmermann M, Birnbaum D, Schmid C, Riegger G A J, Pfeifer M
Department of Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
Eur Respir J. 2009 Mar;33(3):551-8. doi: 10.1183/09031936.00123608. Epub 2008 Nov 14.
Respiratory acidosis can become a serious problem during protective ventilation of severe lung failure. A pumpless arteriovenous interventional lung assist (iLA) for extracorporeal carbon dioxide removal has been used increasingly to control critical respiratory situations. The present study sought to evaluate the factors determining the efficacy of iLA and calculate its contribution to gas exchange. In a cohort of 96 patients with severe acute respiratory distress syndrome, haemodynamic parameters, oxygen consumption and carbon dioxide production as well as gas transfer through the iLA were analysed. The measurements demonstrated a significant dependency of blood flow via the iLA device on cannula size (mean+/-sd 1.59+/-0.52 L x min(-1) for 15 French (Fr), 1.94+/-0.35 L x min(-1) for 17 Fr, and 2.22 +/-0.45 L x min(-1) for 19 Fr) and on mean arterial pressure. Oxygen transfer capacity averaged 41.7+/-20.8 mL x min(-1), carbon dioxide removal was 148.0+/-63.4 mL x min(-1). Within two hours of iLA treatment, arterial oxygen partial pressure/inspired oxygen fraction ratio increased significantly and a fast improvement in arterial carbon dioxide partial pressure and pH was observed. Interventional lung assist eliminates approximately 50% of calculated total carbon dioxide production with rapid normalisation of respiratory acidosis. Despite limited contribution to oxygen transfer it may allow a more protective ventilation in severe respiratory failure.
在重症肺衰竭的保护性通气过程中，呼吸性酸中毒可能会成为一个严重问题。一种用于体外二氧化碳清除的无泵动静脉介入式肺辅助装置（iLA）越来越多地被用于控制危急的呼吸状况。本研究旨在评估决定iLA疗效的因素，并计算其对气体交换的贡献。在一组96例严重急性呼吸窘迫综合征患者中，分析了血流动力学参数、氧耗量和二氧化碳产生量以及通过iLA的气体交换情况。测量结果表明，通过iLA装置的血流量显著依赖于插管尺寸（15法氏（Fr）时平均±标准差为1.59±0.52 L·min⁻¹，17 Fr时为1.94±0.35 L·min⁻¹，19 Fr时为2.22±0.45 L·min⁻¹）以及平均动脉压。氧转运能力平均为41.7±20.8 mL·min⁻¹，二氧化碳清除量为148.0±63.4 mL·min⁻¹。在iLA治疗的两小时内，动脉血氧分压/吸入氧分数比值显著升高，同时观察到动脉二氧化碳分压和pH值迅速改善。介入式肺辅助可消除约50%计算得出的总二氧化碳产生量，使呼吸性酸中毒迅速恢复正常。尽管对氧转运的贡献有限，但它可能允许在严重呼吸衰竭时采用更具保护性的通气方式。
