title: Hemodynamic stability during arteriovenous carbon dioxide removal for adult respiratory distress syndrome: a prospective randomized outcomes study in adult sheep.
abstract: To evaluate the ability of arteriovenous carbon dioxide removal (AVCO2R) to maintain hemodynamic stability during treatment of adult respiratory distress syndrome (ARDS), we used our smoke/burn, LD40 sheep model of ARDS. With onset of ARDS (PaO2/FiO2 < 200) animals were randomized to AVCO2R (n = 20) or SHAM (n = 8). With AVCO2R, the carotid artery (10-14 F) and jugular vein (14-16 F) were cannulated; SHAM received identical management, sparing the vessels. AVCO2R maintained stable hemodynamics compared to SHAM at 48 hours; heart rate (114.8+/-6.1 vs. 110.1+/-11.0 beats/min.), mean arterial pressure (112+/-5.1 vs. 107.0+/-8.5 mm Hg), cardiac output (7.4+/-0.5 vs. 7.5+/-0.9 L/min.), pulmonary arterial pressure (26+/-2.4 vs. 21+/-1.3 mm Hg), pulmonary arterial wedge pressure (14.1+/-1.8 vs. 14.0+/-1.2 mm Hg), and central venous pressure (7+/-1.6 vs. 8+/-0.9 mm Hg). At 48 hours, AVCO2R allowed significant reductions (p<0.05) in minute ventilation (13.6+/-2.5 to 7.6+/-0.8 L/min); tidal volume (TV) (389.4+/-24.1 to 295.0+/-10.1 ml); peak inspiratory pressure (PIP) (25.4+/-9.2 to 18.8+/-2.5 cm H2O); RR (27.5+/-0.7 to 21.6+/-1.8 breaths/min); and FiO2 (0.96+/-0.00 to 0.48+/-0.2) while normocapnia was maintained. AVCO2R is an effective method of CO2 removal during severe respiratory failure that is hemodynamically well tolerated.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children, Galveston 77555-0528, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Jayroe
authors.forename: S K
authors.initials: SK
authors.lastname: Alpard
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.forename: D J
authors.initials: DJ
authors.lastname: Deyo
authors.forename: J A
authors.initials: JA
authors.lastname: Murphy
authors.forename: J B
authors.initials: JB
authors.lastname: Zwischenberger
mesh_terms: D000367:Age Factors; D000818:Animals; D001794:Blood Pressure; D002056:Burns / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood*; D002302:Cardiac Output; D002496:Central Venous Pressure; D004195:Disease Models, Animal; D005112:Extracorporeal Circulation; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D011897:Random Allocation; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*; D015208:Smoke Inhalation Injury / Q000503:physiopathology / Q000628:therapy
chemical_list: D002245:Carbon Dioxide