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

Invited Commentary

Discussion

The first 20% of the full text of this article appears below.

Dr Bartley P. Griffith (Baltimore, Md). Dr Iglesias and Dr Macchiarini, I thank you for what may be a paradigm-shifting manuscript that may in fact change practice to a great degree in this terrible postoperative complication.

[Slides] Some time ago I was interested in the laboratory with pursuing arteriovenous extracorporeal membrane oxygenation as an artificial placenta to mature newborn lamb lungs. We did not recognize then the importance of barotrauma, and we evaluated the shunt required to normalize PO 2. We early learned that by increasing the shunt, we could change PO 2, but the numbers required to do that required a great strain on the heart.

The importance of this paper has been to confirm the concept that Gattinoni brought to us of the "baby lung." We must remember the ARDS patient shown on this computed tomographic scan, the importance of the defunctionalized lung that does not ventilate as opposed to the ventilated lung, which may be as little as a third of each lung. Sixty-six percent of this patient's lung would . . . [Full Text of this Article]


Related Article

Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory distress syndrome
Manuela Iglesias, Philipp Jungebluth, Carole Petit, María Purificación Matute, Irene Rovira, Elisabeth Martínez, Miguel Catalan, José Ramirez, and Paolo Macchiarini
J. Thorac. Cardiovasc. Surg. 2008 135: 1362-1371. [Abstract] [Full Text] [PDF]





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