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Veno‐venous extracorporeal CO 2 removal improves pulmonary hemodynamics in a porcine ARDS model
Author(s) -
MORIMONT P.,
GUIOT J.,
DESAIVE T.,
TCHANASATO V.,
JANSSEN N.,
CAGNINA A.,
HELLA D.,
BLAFFART F.,
DEFRAIGNE J.O.,
LAMBERMONT B.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12497
Subject(s) - medicine , ards , pulmonary artery , pulmonary wedge pressure , anesthesia , tidal volume , ventilation (architecture) , mechanical ventilation , central venous pressure , cardiology , extracorporeal membrane oxygenation , lung , blood pressure , respiratory system , heart rate , mechanical engineering , engineering
Background Protective lung ventilation is recommended in patients with acute respiratory distress syndrome ( ARDS ) to minimize additional injuries to the lung. However, hypercapnic acidosis resulting from ventilation at lower tidal volume enhances pulmonary hypertension and might induce right ventricular ( RV ) failure. We investigated if extracorporeal veno‐venous CO 2 removal therapy could have beneficial effects on pulmonary circulation and RV function. Methods This study was performed on an experimental model of ARDS obtained in eight anaesthetized pigs connected to a volume‐cycled ventilator. A micromanometer‐tipped catheter was inserted into the main pulmonary artery and an admittance micromanometer‐tipped catheter was inserted into the right ventricle. RV –arterial coupling was derived from RV pressure‐volume loops. ARDS was obtained by repeated bronchoalveolar lavage. Protective ventilation was then achieved, and the pigs were connected to a pump‐driven extracorporeal membrane oxygenator ( PALP , M aquet, G ermany) in order to achieve CO 2 removal. Results ARDS induced severe hypercapnic acidosis. Systolic pulmonary artery pressure significantly increased from 29.6 ± 1.8 to 43.9 ± 2.0 mm H g ( P < 0.001). After the PALP was started, acidosis was corrected and normocarbia was maintained despite protective ventilation. Pulmonary artery pressure significantly decreased to 31.6 ± 3.2 mm H g ( P < 0.001) and RV –arterial coupling significantly improved ( RV –arterial coupling index = 1.03 ± 0.33 vs. 0.55 ± 0.41, P < 0.05). Conclusion Veno‐venous CO 2 removal therapy enabled protective ventilation while maintaining normocarbia during ARDS . CO 2 removal decreased pulmonary hypertension and improved RV function. This technique may be an effective lung‐ and RV ‐protective adjunct to mechanical ventilation.