title: Optimal positive end-expiratory pressure during pumpless extracorporeal lung membrane support.
abstract: 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) < or = 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 < or = 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.
authors.affiliation: General Thoracic Surgical Experimental Laboratory, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Philipp
authors.initials: P
authors.lastname: Jungebluth
authors.forename: Manuela
authors.initials: M
authors.lastname: Iglesias
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Go
authors.forename: Oriol
authors.initials: O
authors.lastname: Sibila
authors.forename: Paolo
authors.initials: P
authors.lastname: Macchiarini
mesh_terms: D000818:Animals; D001187:Artificial Organs; D001784:Blood Gas Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics; D008168:Lung / Q000502:physiology*; D008176:Lung Volume Measurements; D008297:Male; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D013552:Swine; D013990:Tidal Volume; D012122:Ventilators, Mechanical