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Optimal Positive End‐Expiratory Pressure During Pumpless Extracorporeal Lung Membrane Support
Author(s) -
Jungebluth Philipp,
Iglesias Manuela,
Go Tetsuhiko,
Sibila Oriol,
Macchiarini Paolo
Publication year - 2008
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2008.00646.x
Subject(s) - positive end expiratory pressure , medicine , anesthesia , tidal volume , mechanical ventilation , extracorporeal , lung , hemodynamics , extracorporeal membrane oxygenation , ventilation (architecture) , respiratory system , physics , thermodynamics
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 ≤ 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 ≤ 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.