Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory.

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Presentation transcript:

Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory distress syndrome Manuela Iglesias, MD, Philipp Jungebluth, Carole Petit, RN, María Purificación Matute, MD, Irene Rovira, MD, Elisabeth Martínez, MD, Miguel Catalan, MD, José Ramirez, MD, Paolo Macchiarini, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 6, Pages 1362-1371.e4 (June 2008) DOI: 10.1016/j.jtcvs.2007.08.074 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Study design. VT, Tidal volume; VM, minute volume; RR, respiratory rate; PEEP, positive-end expiratory pressure; NO, nitric oxide; iLA, interventional lung assist device. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Selective chest x-ray of the right lung taken in pigs instrumented with left pneumonectomy and radical lymphadenectomy without (A, 12 hours postoperatively; Murray score: 0) or with surfactant depletion of the right lung (B, at the onset of a severe postpneumonectomy acute respiratory distress syndrome (ppARDS); Murray score: 3.6 ± 0.5) observed only (C, 3 hours postoperatively), treated with conventional treatment (D, 6 hours ppARDS; Murray score: 2.2 ± 0.5) or extracorporeal lung membrane (E, 12 hours ppARDS; Murray score: 1 ± 0.5). The severity of the ARDS was calculated according to Murray and associates6 and evaluates radiographic consolidation, hypoxemia, level of PEEP, and static lung compliance, whereby ARDS may be absent (0) mild (1–2.5), or severe (>2.5). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Dynamic of the cytokines (IL-6, IL-8, and TNF-α) release of the right lung in pigs treated with left thoracotomy alone (group I), pneumonectomy with radical lymphadenectomy alone (group II), or depletion of surfactant of the right lung followed any further treatment (group III), conventional treatment (IV), or extracorporeal lung membrane and near-static ventilation (group V). The significant (P < .001) increase observed in group III was observed especially during the first hour. Normal concentration ranges in our laboratory are as follows: TNF-α (25–120 μg/mL), IL-6 (<39 μg/mL), and IL-8 (<62 μg/mL). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Dynamic of lung cytokines during the treatment periods in pigs with a post-pneumonectomy acute respiratory distress syndrome (ppARDS) observed only (group III), treated with conventional therapy (group IV), or extracorporeal lung membrane (iLA) and near-static ventilation (group V). Lung cytokines dropped during treatment and not during observation (pig survival, 3 ± 1 hours); however, only in iLA-treated pigs the cytokines returned within normal range (P < .05) and not in pigs belonging to group IV (10 ± 2 hours). The survival of pigs treated with iLA support in combination with near-static ventilation was 80% and fulfilled the extubation criteria (P < .01). Normal concentrations ranges in our laboratory are as follows: TNF-α (25–120 μg/mL), IL-6 (<39 μg/mL), and IL-8 (<62 μg/mL). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Dynamic of the surfactant level in the right lung managed with a postpneumonectomy acute respiratory distress syndrome. There was a significant (P < .05) recovery of surfactant alveolar levels at 12 hours in iLA- treated pigs (group V) compared with the conventional treatment (group III). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Correlation of oxygen (O2) transfer and arteriovenous carbon dioxide (CO2) removal (AVCO2R) to the blood flow perfusing the iLA device. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Correlation of oxygen (O2) transfer and arteriovenous carbon dioxide (CO2) removal (AVCO2R) to the blood flow perfusing the iLA device. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1362-1371.e4DOI: (10.1016/j.jtcvs.2007.08.074) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions