Optimal positive end-expiratory pressure during pumpless extracorporeal lung membrane support |
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Authors: | Jungebluth Philipp Iglesias Manuela Go Tetsuhiko Sibila Oriol Macchiarini Paolo |
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Institution: | General Thoracic Surgical Experimental Laboratory, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. |
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Abstract: | The aim of this study was to determine the optimal positive end-expiratory pressure (PEEP) required during extracorporeal lung membrane support (interventional lung assist iLA]; Novalung GmbH, Hechingen, Germany). Twenty healthy pigs were initially (4 h) mechanically ventilated with a tidal volume (V(T)) of 10 mL/Kg, respiratory rate (RR) of 20 breaths/min, PEEP of 5 cm H(2)O, and fraction of inspired O(2) (FiO(2)) of 1.0. Thereafter, the iLAs were placed arteriovenously transfemorally and settings reduced to reach near static ventilation (V(T) < or = 2 mL/Kg, RR 4 breaths/min, PEEP of 5, FiO(2) 1.0). Then, animals were assigned to four study groups evaluating 5 cm H(2)O increasing levels of PEEP for 8 h. Gas exchanges with PEEP < or = 10 cm H(2)O were significantly worse than those with PEEP > 12 cm H(2)O, and this without hemodynamical imbalance. This study suggests that the iLA may provide adequate gas exchange during static ventilation only with PEEP levels > 10 cm H(2)O, and this without pulmonary or systemic hemodynamic imbalance. |
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Keywords: | Optimal positive end‐expiratory pressure Static ventilation extracorporeal lung membrane support Hemodynamics Blood gases |
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