General Thoracic Surgical Experimental Laboratory, Hospital Clínic, University of Barcelona, Barcelona, Spain.
J Thorac Cardiovasc Surg. 2010 Sep;140(3):558-63, 563.e1-2. doi: 10.1016/j.jtcvs.2009.12.057.
We sought to investigate the safety and feasibility of obtaining total respiratory support during 72 hours using a pump-driven (Levitronix CentriMag; Levitronix LLC, Waltham, Mass) venous-venous extracorporeal lung membrane (Novalung; Novalung GmbH, Hechingen, Germany) attached through a single double-lumen cannula (Novalung) into the femoral or jugular vein in pigs.
Twelve pigs were initially mechanically ventilated for 2 hours (respiratory rate, 20-25 breaths/min; tidal volume, 10-12 mL/kg; fraction of inspired oxygen, 1.0; positive end-expiratory pressure, 5 cm H(2)O). Thereafter, the extracorporeal lung membrane was attached to the right femoral (n = 6, 26F) or jugular (n = 6, 22F) vein by using a single double-lumen cannula placed transcutaneously. Ventilatory settings were then reduced to near-apneic ventilation (respiratory rate, 4 breaths/min; tidal volume, 1-2 mL/kg; fraction of inspired oxygen, 0.21; positive end-expiratory pressure, 10 cm H(2)O), and pump flow was increased hourly until maximal efficacy. Blood gases and hemodynamics were measured hourly, and lung and plasma cytokine levels were measured every 4 hours.
The device's mean blood flow was 2.16 +/- 0.43 L/min, permitting an oxygen transfer and carbon dioxide removal of 203.6 +/- 54.6 and 590.3 +/- 23.3 mL/min, respectively. Despite static ventilation, all pigs showed optimal respiratory support, with a PaO(2), PaCO(2), and mixed venous oxygen saturation of 226.2 +/- 56.4, 59.7 +/- 8.8, and 85.6 +/- 5.3 mm Hg, respectively. There were no significant inflammatory, cellular, or coagulatory responses; lung cytokine levels remained in the normal range. Route (femoral vs jugular) or size (22F vs 26F) of the cannula did not change hemodynamic or respiratory parameters significantly.
This circuit provides total respiratory support over 72 hours without inducing significant hemodynamic, coagulatory, cellular, or inflammatory responses.
我们旨在研究通过泵驱动（Levitronix CentriMag；Levitronix 有限责任公司，沃尔瑟姆，马萨诸塞州）静脉-静脉体外肺膜（Novalung；Novalung GmbH，海钦根，德国）在通过经皮放置的单个双腔管（Novalung）连接到股静脉或颈静脉中，在 72 小时内获得总呼吸支持的安全性和可行性。
最初，12 头猪接受 2 小时的机械通气（呼吸频率 20-25 次/分钟；潮气量 10-12 毫升/公斤；吸入氧分数 1.0；呼气末正压 5 厘米 H2O）。此后，通过经皮放置的单个双腔管将体外肺膜连接到右股静脉（n = 6，26F）或颈静脉（n = 6，22F）。然后，将通气设置降低至接近呼吸暂停通气（呼吸频率 4 次/分钟；潮气量 1-2 毫升/公斤；吸入氧分数 0.21；呼气末正压 10 厘米 H2O），并每小时增加泵流量直至达到最大疗效。每小时测量血气和血液动力学，每 4 小时测量肺和血浆细胞因子水平。
该设备的平均血流速度为 2.16 +/- 0.43 升/分钟，允许的氧气转移和二氧化碳去除分别为 203.6 +/- 54.6 和 590.3 +/- 23.3 毫升/分钟。尽管进行了静态通气，但所有猪都表现出最佳的呼吸支持，其 PaO2、PaCO2 和混合静脉血氧饱和度分别为 226.2 +/- 56.4、59.7 +/- 8.8 和 85.6 +/- 5.3 毫米汞柱。没有明显的炎症、细胞或凝血反应；肺细胞因子水平仍处于正常范围。导管的路径（股静脉与颈静脉）或大小（22F 与 26F）并没有显著改变血液动力学或呼吸参数。
该回路在 72 小时内提供了全面的呼吸支持，而不会引起明显的血液动力学、凝血、细胞或炎症反应。
