Department of Cardiology, Nanjing Lishui People's Hospital, Nanjing, 211100, China.
Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China.
J Artif Organs. 2021 Sep;24(3):336-342. doi: 10.1007/s10047-021-01253-9. Epub 2021 Mar 9.
To observe the effect of continuous renal replacement therapy (CRRT) combined with low-flow extracorporeal membrane oxygenation (ECMO) of V-V mode on anti-inflammation, improving oxygenation and reducing PCO in canines with acute respiratory distress syndrome (ARDS) and hypercapnia. A total of 30 healthy adult canines were randomly divided into sham group (n = 10), ECMO (EC) group (n = 10) and CRRT + ECMO (CR + EC) group (n = 10). Sham group was only treated with invasive mechanical ventilation. EC group was also treated with ECMO. CR + EC group was treated with CRRT combined with low-flow ECMO of V-V mode besides invasive mechanical ventilation. The results showed that hazard ratio was lower in the CR + EC group. Inflammatory factors, OI values, and PaCO levels were lower in the CR + EC group. There was no significant difference in the levels of MAP, CO and T among the three groups. No significant complications or death was developed in the three groups. Compared with ECMO group at T3, T6 and T9, IL-6 [(276.13 ± 8.32, 262.04 ± 7.15, 259.33 ± 7.31)ng/L VS (352.67 ± 19.24, 360.24 ± 23.58, 362.21 ± 25.24)ng/L] and TNF-α [(50.14 ± 1.75, 50.45 ± 1.81, 48.03 ± 1.24) ng/L VS (70.25 ± 3.02, 72.45 ± 3.25, 76.69 ± 2.18)ng/L] in CR + EC group were decreased (P < 0.0001). Compared with sham group, IL-6 [(343.76 ± 21.97, 345.91 ± 19.89, 340.34 ± 22.17)ng/L]and TNF-α [(68.10 ± 2.96, 67.31 ± 3.01, 70.34 ± 3.35)ng/L] of T3, T6 and T9 in CR + EC group were lower (P < 0.0001). These findings indicated that CRRT combined with low-flow ECMO of V-V mode had a positive effect on anti-inflammation, oxygenation improvement and surplus blood CO removal in canines with ARDS and hypercapnia. These results provide a promising treatment regimen for ARDS.
观察连续肾脏替代治疗（CRRT）联合 V-V 模式低流量体外膜肺氧合（ECMO）对伴有高碳酸血症的急性呼吸窘迫综合征（ARDS）犬的抗炎、改善氧合和降低 PCO 的影响。将 30 只健康成年犬随机分为假手术组（n = 10）、ECMO 组（EC 组，n = 10）和 CRRT + ECMO 组（CR + EC 组，n = 10）。假手术组仅接受有创机械通气。EC 组还接受 ECMO 治疗。CR + EC 组除有创机械通气外，还采用 CRRT 联合 V-V 模式低流量 ECMO 治疗。结果表明，CR + EC 组的危害比更低。CR + EC 组的炎症因子、OI 值和 PaCO 水平更低。三组间 MAP、CO 和 T 水平无显著性差异。三组均未发生明显并发症或死亡。与 ECMO 组 T3、T6 和 T9 时比较，IL-6[(276.13 ± 8.32、262.04 ± 7.15、259.33 ± 7.31)ng/L 比（352.67 ± 19.24、360.24 ± 23.58、362.21 ± 25.24)ng/L]和 TNF-α[(50.14 ± 1.75、50.45 ± 1.81、48.03 ± 1.24)ng/L 比（70.25 ± 3.02、72.45 ± 3.25、76.69 ± 2.18)ng/L]降低（P < 0.0001）。与假手术组比较，CR + EC 组 T3、T6 和 T9 时 IL-6[(343.76 ± 21.97、345.91 ± 19.89、340.34 ± 22.17)ng/L]和 TNF-α[(68.10 ± 2.96、67.31 ± 3.01、70.34 ± 3.35)ng/L]降低（P < 0.0001）。这些发现表明，CRRT 联合 V-V 模式低流量 ECMO 对伴有高碳酸血症的 ARDS 犬具有抗炎、改善氧合和清除多余血 CO 的积极作用。这些结果为 ARDS 提供了一种有前途的治疗方案。
