Brunston R L, Tao W, Bidani A, Alpard S K, Traber D L, Zwischenberger J B
Department of Surgery, University of Texas Medical Branch, Galveston 77550-0528, USA.
J Thorac Cardiovasc Surg. 1997 Dec;114(6):1107-14. doi: 10.1016/S0022-5223(97)70026-6.
The effects of prolonged arteriovenous carbon dioxide removal on hemodynamics during severe respiratory failure were evaluated in adult sheep with severe smoke inhalation injury.
Adult female sheep (n = 6,33.8 +/- 5.2 kg) were subjected to intratracheal cotton severe smoke insufflation to a mean carboxyhemoglobin level of 83% +/- 3%. Twenty-four hours after injury, a low-resistance 2.5 m2 membrane oxygenator was placed in a carotid-to-jugular pumpless arteriovenous shunt at unrestricted flow to allow complete carbon dioxide removal and reductions in ventilator support. Animals remained conscious, and heart rate, cardiac output, mean arterial pressure, and pulmonary arterial pressure were measured at baseline, after injury, and daily during support with the arteriovenous carbon dioxide removal circuit for 7 days.
All animals survived the study period. Carbon dioxide removal ranged from 99.7 +/- 13.7 to 152.2 +/- 16.2 ml/min, and five (83%) of the six animals were successfully weaned from the ventilator before day 7. During full support with the arteriovenous carbon dioxide removal circuit, shunt flow ranged from 1.24 +/- 0.06 to 1.43 +/- 0.08 L/min and accounted for 20.1% +/- 1.4% to 25.9% +/- 2.4% of cardiac output. No statistically significant changes in heart rate, cardiac output, mean arterial pressure, or pulmonary artery pressure were demonstrated over the study course despite the extracorporeal shunt flow.
Arteriovenous carbon dioxide removal as a simplified means of extracorporeal gas exchange support is relatively safe without adverse hemodynamic effects or complications.
在患有严重烟雾吸入性损伤的成年绵羊中，评估长时间动静脉二氧化碳清除对严重呼吸衰竭期间血流动力学的影响。
成年雌性绵羊（n = 6，体重33.8±5.2千克）经气管内注入棉花严重烟雾，使平均碳氧血红蛋白水平达到83%±3%。损伤24小时后，将一个低阻力2.5平方米的膜式氧合器置于颈动脉至颈静脉无泵动静脉分流处，以无限制流量运行，以实现完全二氧化碳清除并减少呼吸机支持。动物保持清醒，在基线、损伤后以及使用动静脉二氧化碳清除回路支持的7天内每天测量心率、心输出量、平均动脉压和肺动脉压。
所有动物均存活至研究结束。二氧化碳清除量在99.7±13.7至152.2±16.2毫升/分钟之间，6只动物中有5只（83%）在第7天前成功脱机。在使用动静脉二氧化碳清除回路全力支持期间，分流流量在1.24±0.06至1.43±0.08升/分钟之间，占心输出量的20.1%±1.4%至25.9%±2.4%。尽管有体外分流流量，但在整个研究过程中心率、心输出量、平均动脉压或肺动脉压均未显示出统计学上的显著变化。
动静脉二氧化碳清除作为一种简化的体外气体交换支持手段相对安全，不会产生不良血流动力学影响或并发症。
