PrismaLung+体外特性：一种新型体外心肺复苏设备
In vitro characterization of PrismaLung+: a novel ECCOR device.
作者信息
Hospach Ingeborg, Goldstein Jacques, Harenski Kai, Laffey John G, Pouchoulin Dominique, Raible Manuela, Votteler Stefanie, Storr Markus
机构信息
Baxter International, Research and Development, Holger-Crafoord-Str. 26, 72379, Hechingen, Germany.
Baxter World Trade SPRL, Acute Therapies Global, Braine-l'Alleud, Belgium.
出版信息
Intensive Care Med Exp. 2020 May 13;8(1):14. doi: 10.1186/s40635-020-00301-7.
BACKGROUND
Invasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury. Advances in extracorporeal CO removal (ECCOR) technologies may facilitate more protective lung ventilation in acute respiratory distress syndrome, and enable earlier weaning and/or avoid invasive mechanical ventilation entirely in chronic obstructive pulmonary disease exacerbations. We evaluated the in vitro CO removal capacity of the novel PrismaLung+ ECCOR device compared with two existing gas exchangers.
METHODS
The in vitro CO removal capacity of the PrismaLung+ (surface area 0.8 m, Baxter) was compared with the PrismaLung (surface area 0.35 m, Baxter) and A.L.ONE (surface area 1.35 m, Eurosets) devices, using a closed-loop bovine blood-perfused extracorporeal circuit. The efficacy of each device was measured at varying pCO inlet (pCO) levels (45, 60, and 80 mmHg) and blood flow rates (Q) of 200-450 mL/min; the PrismaLung+ and A.L.ONE devices were also tested at a Q of 600 mL/min. The amount of CO removed by each device was assessed by measurement of the CO infused to maintain circuit equilibrium (CO infusion method) and compared with measured CO concentrations in the inlet and outlet of the CO removal device (blood gas analysis method).
RESULTS
The PrismaLung+ device performed similarly to the A.L.ONE device, with both devices demonstrating CO removal rates ~ 50% greater than the PrismaLung device. CO removal rates were 73 ± 4.0, 44 ± 2.5, and 72 ± 1.9 mL/min, for PrismaLung+, PrismaLung, and A.L.ONE, respectively, at Q 300 mL/min and pCO 45 mmHg. A Bland-Altman plot demonstrated that the CO infusion method was comparable to the blood gas analysis method for calculating CO removal. The resistance to blood flow across the test device, as measured by pressure drop, varied as a function of blood flow rate, and was greatest for PrismaLung and lowest for the A.L.ONE device.
CONCLUSIONS
The newly developed PrismaLung+ performed more effectively than PrismaLung, with performance of CO removal comparable to A.L.ONE at the flow rates tested, despite the smaller membrane surface area of PrismaLung+ versus A.L.ONE. Clinical testing of PrismaLung+ is warranted to further characterize its performance.
背景
有创机械通气在严重急性呼吸衰竭的情况下可挽救生命，但可能导致通气诱导的肺损伤。体外二氧化碳清除（ECCOR）技术的进展可能有助于在急性呼吸窘迫综合征中实现更具保护性的肺通气，并能在慢性阻塞性肺疾病急性加重期更早撤机和/或完全避免有创机械通气。我们评估了新型PrismaLung+ ECCOR设备与两种现有气体交换器相比的体外二氧化碳清除能力。
方法
使用闭环牛血灌注体外循环，将PrismaLung+（表面积0.8平方米，百特公司）的体外二氧化碳清除能力与PrismaLung（表面积0.35平方米，百特公司）和A.L.ONE（表面积1.35平方米，欧洲集束公司）设备进行比较。在不同的入口二氧化碳分压（pCO₂）水平（45、60和80 mmHg）和200 - 450 mL/min的血流速率（Q）下测量每个设备的效能；PrismaLung+和A.L.ONE设备还在600 mL/min的Q下进行了测试。通过测量为维持回路平衡而注入的二氧化碳量（二氧化碳注入法）评估每个设备清除的二氧化碳量，并与二氧化碳清除设备入口和出口处测量的二氧化碳浓度（血气分析法）进行比较。
结果
PrismaLung+设备的表现与A.L.ONE设备相似，两种设备的二氧化碳清除率均比PrismaLung设备高约50%。在Q为300 mL/min和pCO₂为45 mmHg时，PrismaLung+、PrismaLung和A.L.ONE的二氧化碳清除率分别为73±4.0、44±2.5和72±1.9 mL/min。布兰德 - 奥特曼图表明，在计算二氧化碳清除方面，二氧化碳注入法与血气分析法具有可比性。通过压降测量的跨测试设备的血流阻力随血流速率而变化，PrismaLung的阻力最大，A.L.ONE设备的阻力最小。
结论
新开发的PrismaLung+比PrismaLung表现更有效，在所测试的流速下，其二氧化碳清除性能与A.L.ONE相当，尽管PrismaLung+的膜表面积比A.L.ONE小。有必要对PrismaLung+进行临床测试以进一步表征其性能。
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