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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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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. |
format | Online Article Text |
id | pubmed-9038965 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
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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