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J Thorac Cardiovasc Surg 2008;135:1362-1371
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory distress syndrome

Manuela Iglesias, MDa,b, Philipp Jungeblutha,b, Carole Petit, RNa,f, María Purificación Matute, MDc, Irene Rovira, MDc, Elisabeth Martínez, MDa,b, Miguel Catalan, MDa,b, José Ramirez, MDd,f,g, Paolo Macchiarini, MD, PhDa,b,e,f,g,*

a General Thoracic Surgical Experimental Laboratory, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
b Department of General Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
c Department of Anesthesiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
d Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
e Ciber Enfermedades Respiratorias, Barcelona, Spain
f Fundació Clínic, Barcelona, Spain
g Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Spain

Received for publication May 28, 2007; revisions received August 1, 2007; accepted for publication August 27, 2007.

* Address for reprints: Paolo Macchiarini, MD, PhD, Department of General Thoracic Surgery, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain. (Email: pmacchiarini{at}ub.edu).

Objective: We compared conventional treatment with pumpless extracorporeal lung membrane (Interventional Lung Assist [iLA] Novalung; Novalung GmbH, Hechingen, Germany) support in a pig model of postpneumonectomy severe acute respiratory distress syndrome.

Methods: Adult pigs underwent a left thoracotomy without (group I) or with a left extrapericardial pneumonectomy and radical lymphadenectomy (groups II to V). After stabilization, pigs belonging to group II were observed only, whereas in those belonging to groups III to V, a surfactant-depletion severe (PaO 2/FIO 2 < 100) postpneumonectomy acute respiratory distress syndrome was induced. This was followed by observation (group III); treatment with conventional therapy including protective ventilation, steroids, and nitric oxide (group IV); or femoral arteriovenous iLA Novalung placement, near-static ventilation, steroids, and nitric oxide (group V). Each group included 5 animals. Primary outcome was extubation 12 hours postoperatively or postpneumonectomy acute respiratory distress syndrome.

Results: A severe postpneumonectomy acute respiratory distress syndrome was obtained after 9 ± 2 alveolar lavages over 90 ± 20 minutes. In group V pigs, the iLA Novalung device diverted 17% ± 4% of the cardiac output, permitted an oxygen transfer and carbon dioxide removal of 298.4 ± 173.7 mL/min and 287.7 ± 87.3 mL/min, respectively, and static ventilation (tidal volume, 2.2 ± 1 mL/kg; respiratory rate, 6 ± 2.9 breaths/min). All but 1 pig belonging to group V could be extubated compared with none in groups III and IV (P < .01), and only their lungs normalized cytokine release (P < .001) and surfactant (P < .03) and displayed fewer parenchymal lesions (P < .05).

Conclusions: The pumpless extracorporeal lung membrane and near-static ventilation achieved a significantly better outcome than conventional treatment in this pig model of severe postpneumonectomy acute respiratory distress syndrome, probably because the injured lungs were not forced to work and this "rest" gave them more time to heal.

Abbreviations and Acronyms ARDS = acute respiratory distress syndrome; AVCO2R = extracorporeal carbon dioxide removal; BAL = bronchoalveolar lavage; CO = cardiac output; FIO 2 = inspired oxygen fraction; IL = interleukin; iLA = interventional lung assist; MV = mechanical ventilation; OR = odds ratio; PEEP = positive end-expiratory pressure; ppARDS = postpneumonectomy acute respiratory distress syndrome; TNF-{alpha} = tumor necrosis factor {alpha}


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Discussion
J. Thorac. Cardiovasc. Surg. 2008 135: 1371. [Extract] [Full Text] [PDF]





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