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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 Agosto;77(8):797-801
Interventional lung assist enables lung protective mechanical ventilation in acute respiratory distress syndrome
Nierhaus A. 1, Frings D. P. 1, Braune S. 1, Baumann H.-J. 2, Schneider C. 3, Wittenburg B. 1, Kluge S. 1 ✉
1 Department of Critical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
2 Department of Pulmonology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
3 Department of General Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
BACKGROUND:The feasibility and safety of a pumpless arteriovenous extracorporeal lung assist system (pECLA) has been demonstrated in previous studies of patients with severe respiratory insufficiency. The aim of this report was to examine whether pECLA is feasible in a center that is new to the technology and to determine the positive and adverse effects associated with its use.
METHODS: This was a retrospective case series of 13 consecutive patients with established acute respiratory distress syndrome (ICU patients with ARDS or ALI) at a university hospital. Management consisted of transcutaneous placement of a femoral arteriovenous pECLA to allow lung-protective ventilation. Nonparametric statistics were applied; all data are values and standard deviations (SD).
RESULTS:Mean simplified acute physiology score (SAPS) II was 49.5 (26); ICU mortality was 54% (7/13). Mean length of ICU stay was 34.5 (65.3) days for survivors (S) and 36 (32.8) days for non-survivors (NS). Total time on arteriovenous pECLA was 12.0 (22.2) days (S) and 7.0(7.8) days (NS), total time on mechanical ventilation was 31.0 (28.2) (S) and 32.0 (15.2) days (NS). Hypercapnia was significantly (P<0.05) reduced from 80.0 (23.0) (pre-pECLA) to 48.0 (13.0) mmHg (day 7), as were minute ventilation and inspiratory pressure. pECLA was accompanied by a significant (P<0.05) increase in the PaO2/fraction of inspired oxygen (P/F) ratio from 100.0 (28.9) (pre-pECLA) to 191.1 (114.3) mmHg after 7 days of treatment. Major complications were two inadvertent decannulations in the first two patients treated; there was one minor bleeding event in a patient seen subsequently.
CONCLUSION:pECLA is an effective and manageable technique to support gas exchange in ARDS patients. This retrospective case series demonstrates the feasibility of pECLA in a center that did not have prior experience with this technique. pECLA may decrease further lung injury by minimizing the amount of time for which the lung is exposed to high stress and/or strain.