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Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure

BACKGROUND: Veno-venous extracorporeal membrane oxygenation (ECMO) provides blood oxygenation and carbon dioxide removal in acute respiratory distress syndrome. However, during ECMO support, the native lungs still play an important role in gas exchange, functioning as a second oxygenator in series w...

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Autores principales: Mendes, Pedro Vitale, Park, Marcelo, de Azevedo, Luciano Cesar Pontes, Morais, Caio Cesar Araujo, Amato, Marcelo Brito Passos, Costa, Eduardo Leite Vieira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9038965/
https://www.ncbi.nlm.nih.gov/pubmed/35467225
http://dx.doi.org/10.1186/s40635-022-00442-x
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author Mendes, Pedro Vitale
Park, Marcelo
de Azevedo, Luciano Cesar Pontes
Morais, Caio Cesar Araujo
Amato, Marcelo Brito Passos
Costa, Eduardo Leite Vieira
author_facet Mendes, Pedro Vitale
Park, Marcelo
de Azevedo, Luciano Cesar Pontes
Morais, Caio Cesar Araujo
Amato, Marcelo Brito Passos
Costa, Eduardo Leite Vieira
author_sort Mendes, Pedro Vitale
collection PubMed
description BACKGROUND: Veno-venous extracorporeal membrane oxygenation (ECMO) provides blood oxygenation and carbon dioxide removal in acute respiratory distress syndrome. However, during ECMO support, the native lungs still play an important role in gas exchange, functioning as a second oxygenator in series with ECMO. The hypoxic vasoconstriction mechanism diverts regional blood flow within the lungs away from regions with low oxygen levels, optimizing ventilation/perfusion matching. ECMO support has the potential to reduce this adaptive pulmonary response and worsen the ventilation/perfusion mismatch by raising venous oxygen partial pressure. Thus, the objective of this study was to evaluate the effect of ECMO on regional pulmonary perfusion and pulmonary hemodynamics during unilateral ventilation and posterior lung collapse. METHODS: Five Agroceres pigs were instrumented, monitored and submitted to ECMO. We used the Electrical Impedance Tomography (EIT) to evaluate lung ventilation and perfusion in all protocol steps. Effects of ECMO support on pulmonary hemodynamics and perfusion involving two different scenarios of ventilation/perfusion mismatch: (1) right-lung selective intubation inducing collapse of the normal left lung and (2) dorsal lung collapse after repeated lung lavage. Data including hemodynamics, respiratory, lung perfusion/ventilation, and laboratory data over time were analyzed with a mixed generalized model using the subjects as a random factor. RESULTS: The initiation of ECMO support provided a significant reduction in Mean Pulmonary Artery Pressure (PAPm) in both situations of ventilation/perfusion mismatch. However, distribution of lung perfusion did not change with the use of ECMO support. CONCLUSIONS: We found that the use of ECMO support with consequent increase in venous oxygen pressure induced a significant drop in PAPm with no detectable effect on regional lung perfusion in different scenarios of ventilation/perfusion mismatch. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40635-022-00442-x.
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spelling pubmed-90389652022-05-07 Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure Mendes, Pedro Vitale Park, Marcelo de Azevedo, Luciano Cesar Pontes Morais, Caio Cesar Araujo Amato, Marcelo Brito Passos Costa, Eduardo Leite Vieira Intensive Care Med Exp Research Articles BACKGROUND: Veno-venous extracorporeal membrane oxygenation (ECMO) provides blood oxygenation and carbon dioxide removal in acute respiratory distress syndrome. However, during ECMO support, the native lungs still play an important role in gas exchange, functioning as a second oxygenator in series with ECMO. The hypoxic vasoconstriction mechanism diverts regional blood flow within the lungs away from regions with low oxygen levels, optimizing ventilation/perfusion matching. ECMO support has the potential to reduce this adaptive pulmonary response and worsen the ventilation/perfusion mismatch by raising venous oxygen partial pressure. Thus, the objective of this study was to evaluate the effect of ECMO on regional pulmonary perfusion and pulmonary hemodynamics during unilateral ventilation and posterior lung collapse. METHODS: Five Agroceres pigs were instrumented, monitored and submitted to ECMO. We used the Electrical Impedance Tomography (EIT) to evaluate lung ventilation and perfusion in all protocol steps. Effects of ECMO support on pulmonary hemodynamics and perfusion involving two different scenarios of ventilation/perfusion mismatch: (1) right-lung selective intubation inducing collapse of the normal left lung and (2) dorsal lung collapse after repeated lung lavage. Data including hemodynamics, respiratory, lung perfusion/ventilation, and laboratory data over time were analyzed with a mixed generalized model using the subjects as a random factor. RESULTS: The initiation of ECMO support provided a significant reduction in Mean Pulmonary Artery Pressure (PAPm) in both situations of ventilation/perfusion mismatch. However, distribution of lung perfusion did not change with the use of ECMO support. CONCLUSIONS: We found that the use of ECMO support with consequent increase in venous oxygen pressure induced a significant drop in PAPm with no detectable effect on regional lung perfusion in different scenarios of ventilation/perfusion mismatch. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40635-022-00442-x. Springer International Publishing 2022-04-25 /pmc/articles/PMC9038965/ /pubmed/35467225 http://dx.doi.org/10.1186/s40635-022-00442-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Articles
Mendes, Pedro Vitale
Park, Marcelo
de Azevedo, Luciano Cesar Pontes
Morais, Caio Cesar Araujo
Amato, Marcelo Brito Passos
Costa, Eduardo Leite Vieira
Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title_full Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title_fullStr Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title_full_unstemmed Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title_short Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
title_sort lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9038965/
https://www.ncbi.nlm.nih.gov/pubmed/35467225
http://dx.doi.org/10.1186/s40635-022-00442-x
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