ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Recently, the existence of a relationship was reported between the severity of lung injury and the serum level of F2-isoprostane, a known oxidative stress marker. Recent reports have suggested that direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX) may improve the oxygenation in patients with acute lung injury and acute respiratory distress syndrome. Because cases of septic shock associated with respiratory diseases have poor outcomes, we selected cases of septic shock associated with respiratory disease to review the characteristics of the treatment-resistant cases. ⋯ Four patients survived and 9 died. Only the F2-Isoprostane level was significantly high in B group (p = 0.0228). A relationship between F2-Isoplostane and rebellious cases by DHP-PMX in severe respiratory disease patients became clear.
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We hypothesized that apneic oxygenation, using an open lung approach, combined with extracorporeal CO2 removal, would provide adequate gas exchange in acute lung injury. We tested this hypothesis in nine anesthetized and mechanically ventilated pigs (85-95 kg), in which surfactant was depleted from the lungs by repeated lung lavage. After a lung recruitment maneuver, the tracheal tube was connected to 20 cm H2O continuous pressure (100% O2) for oxygenation of the blood. ⋯ PaCO2 increased asymptotic towards 60 mm Hg. The CO2 removal through the membrane ventilator was 180 (150, 180) ml/min. Thus, the method provided adequate gas exchange in this experimental model, suggesting that it might have potential as an alternative treatment modality in acute lung injury.
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Multicenter Study Comparative Study
Multicenter comparative study of conventional mechanical gas ventilation to tidal liquid ventilation in oleic acid injured sheep.
We performed a multicenter study to test the hypothesis that tidal liquid ventilation (TLV) would improve cardiopulmonary, lung histomorphological, and inflammatory profiles compared with conventional mechanical gas ventilation (CMV). Sheep were studied using the same volume-controlled, pressure-limited ventilator systems, protocols, and treatment strategies in three independent laboratories. Following baseline measurements, oleic acid lung injury was induced and animals were randomized to 4 hours of CMV or TLV targeted to "best PaO2" and PaCO2 35 to 60 mm Hg. ⋯ No significant laboratories by treatment group interactions were found. In summary, TLV resulted in improved cardiopulmonary physiology at lower ventilatory requirements with more favorable histological and inflammatory profiles than CMV. As such, TLV offers a feasible ventilatory alternative as a lung protective strategy in this model of acute lung injury.
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The purpose of this study was to report retrospectively the summarized clinical findings from 20 consecutive pediatric extracorporeal membrane oxygenation (ECMO) patients and to investigate the factors associated with mortality. The ECMO circuit system was completely covered using heparin-coating technique, and venoarterial ECMO was used in all patients. Heparin dosage was 4-20 U/kg/h and active clotting time was maintained between 146 and 360 seconds. ⋯ Lactic acid concentration of artery blood before ECMO in survivor patients was significantly lower than in nonsurvivor patients (p = 0.009); patient weight between two groups also had statistical difference (p = 0.046). ECMO effectively treats cardiac and pulmonary failure secondary to cardiac surgeries for complicated congenital heart diseases. Early application of ECMO in patients with cardiac and respiratory failure is still the key point of success in preventing vital organs from irreversible damage.
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In trauma patients, continuous arteriovenous (AV) rewarming can effectively reverse hypothermia even if associated with hypovolemia. In battlefield conditions, however, portable fluid warmers driven by battery power show limited capacities. We studied the efficacy and safety of a portable fluid warmer that utilizes controlled hydrocarbon combustion (nonflame) for heat generation during continuous AV rewarming in a large animal model of hypothermia and hemorrhagic shock. ⋯ Rewarming after hypothermia took 45 +/- 6 minutes (hypothermia 1) and 55 +/- 6 minutes (hypothermia 2), respectively. The AV-shunt flow was correlated to the cardiac output and affected neither cardiac output nor regional blood flow at any time point during the experiment. Arteriovenous rewarming, using the tested portable fluid warmer, effectively reversed hypothermia without compromising hemodynamics or regional blood flow.