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- Title
High- versus Low-Flow Extracorporeal Respiratory Support in Experimental Hypoxemic Acute Lung Injury.
- Authors
Brusatori, Serena; Zinnato, Carmelo; Busana, Mattia; Romitti, Federica; Gattarello, Simone; Palumbo, Maria Michela; Pozzi, Tommaso; Steinberg, Irene; Palermo, Paola; Lazzari, Stefano; Maj, Roberta; Velati, Mara; D'Albo, Rosanna; Wassong, Jona; Meissner, Killian; Lombardo, Fabio; Herrmann, Peter; Quintel, Michael; Moerer, Onnen; Camporota, Luigi
- Abstract
Rationale: In the EOLIA (ECMO to Rescue Lung Injury in Severe ARDS) trial, oxygenation was similar between intervention and conventional groups, whereas V_ E was reduced in the intervention group. Comparable reductions in ventilation intensity are theoretically possible with low-flow extracorporeal CO2 removal (ECCO2R), provided oxygenation remains acceptable. Objectives: To compare the effects of ECCO2R and extracorporeal membrane oxygenation (ECMO) on gas exchange, respiratory mechanics, and hemodynamics in animal models of pulmonary (intratracheal hydrochloric acid) and extrapulmonary (intravenous oleic acid) lung injury. Methods: Twenty-four pigs with moderate to severe hypoxemia (PaO2:FIO2<150 mm Hg) were randomized to ECMO (blood flow 50-60 ml/kg/min), ECCO2R (0.4 L/min), or mechanical ventilation alone. Measurements and Main Results: V_ O2, V_ CO2, gas exchange, hemodynamics, and respiratory mechanics were measured and are presented as 24-hour averages. Oleic acid versus hydrochloric acid showed higher extravascular lung water (1,4246419 vs. 5746195 ml; P,0.001), worse oxygenation (PaO2:FIO2=125614 vs. 151611 mm Hg; P,0.001), but better respiratory mechanics (plateau pressure 2764 vs. 3063 cm H2O; P=0.017). Both models led to acute severe pulmonary hypertension. In both models, ECMO (3.760.5 L/min), compared with ECCO2R (0.4 L/min), increased mixed venous oxygen saturation and oxygenation, and improved hemodynamics (cardiac output=6.061.4 vs. 5.261.4 L/min; P=0.003). V_ O2 and V_ CO2, irrespective of lung injury model, were lower during ECMO, resulting in lower PaCO2 and V_ E but worse respiratory elastance compared with ECCO2R (64627 vs. 4068 cm H2O/L; P,0.001). Conclusions: ECMO was associated with better oxygenation, lower V_ O2, and better hemodynamics. ECCO2R may offer a potential alternative to ECMO, but there are concerns regarding its effects on hemodynamics and pulmonary hypertension.
- Publication
American Journal of Respiratory & Critical Care Medicine, 2023, Vol 207, Issue 9, p1183
- ISSN
1073-449X
- Publication type
Article
- DOI
10.1164/rccm.202212-2194OC