Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China.
Artif Organs. 2014 Mar;38(3):215-23. doi: 10.1111/aor.12154. Epub 2013 Dec 11.
Pulmonary changes in veno-venous extracorporeal membrane oxygenation (VV-ECMO) are rarely determined. We compared the contribution of VV-ECMO and cannulation based on the observation of pulmonary inflammatory reaction and parenchymal construction in a porcine model of low tidal volume (VT ) ventilation. We also evaluated the effect of adding continuous renal replacement therapy (CRRT) to the ECMO circuit, because CRRT is known to reduce systemic cytokine release induced by VV-ECMO. A total of 18 pigs undergoing low-VT ventilation were randomly divided into three groups (group 1, cannulation; group 2, VV-ECMO; group 3, VV-ECMO + CRRT) and studied for 24 h. Hemodynamic and ventilation parameters were recorded. We assessed plasma and alveolar cytokines, expression of pulmonary inflammatory genes, histopathological grading, and ultrastructural changes of the lungs. During the process, inspiratory volume increased and PaO2 decreased in group 1. Systemic tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) levels increased at 2 h in group 2 and partly decreased in group 3. At 24 h, the levels of bronchoalveolar lavage fluid, TNF-α, and IL-6 in group 2 were remarkably higher than those in groups 1 and 3. Pulmonary mRNA expression of cytokines did not differ between the groups. We observed an increased score of pulmonary pathological findings in pro-inflammatory cell infiltration and interstitial thickening of the lungs in group 2. The epithelium of the blood-air barrier after VV-ECMO was swollen. In group 3, the pulmonary parenchyma and blood-air barrier were well preserved. We concluded that in a porcine model of low-VT ventilation, both VV-ECMO and VV-ECMO in combination with CRRT provided adequate oxygenation and carbon dioxide removal. Compared with VV-ECMO alone, VV-ECMO in combination with CRRT better preserved the lung parenchyma by eliminating systemic cytokines.
静脉-静脉体外膜肺氧合（VV-ECMO）中肺部的变化很少被确定。我们通过观察低潮气量（VT）通气的猪模型中的肺炎症反应和实质结构，比较了 VV-ECMO 和插管的贡献。我们还评估了在 ECMO 回路中添加连续肾脏替代治疗（CRRT）的效果，因为已知 CRRT 可降低 VV-ECMO 引起的全身细胞因子释放。总共 18 头接受低-VT 通气的猪被随机分为三组（组 1，插管；组 2，VV-ECMO；组 3，VV-ECMO+CRRT），并进行了 24 小时研究。记录血流动力学和通气参数。我们评估了血浆和肺泡细胞因子、肺炎症基因表达、组织病理学分级以及肺的超微结构变化。在此过程中，组 1 的吸气量增加，PaO2 降低。组 2 的全身肿瘤坏死因子-α（TNF-α）和白细胞介素 6（IL-6）水平在 2 小时时升高，并在组 3 中部分降低。在 24 小时时，组 2 的支气管肺泡灌洗液、TNF-α 和 IL-6 水平明显高于组 1 和组 3。各组之间的细胞因子支气管肺泡灌洗液 TNF-α和 IL-6 水平无差异。我们观察到组 2 中促炎细胞浸润和肺间质增厚的肺病理发现评分增加。VV-ECMO 后的气血屏障上皮肿胀。在组 3 中，肺实质和气血屏障得到了很好的保留。我们得出结论，在低-VT 通气的猪模型中，VV-ECMO 和 VV-ECMO 联合 CRRT 均提供了充足的氧合和二氧化碳去除。与单独 VV-ECMO 相比，VV-ECMO 联合 CRRT 通过消除全身细胞因子更好地保留了肺实质。
