Abstract
Objective
To evaluate the possibility of reducing ventilator settings to “safe” levels by extrapulmonary gas exchange with IVOX in ARDS patients.
Design
Uncontrolled open clinical study.
Setting
Medical Intensive Care Unit of a University Hospital.
Patients
6 patients with ARDS who entered into IVOX phase II clinical trials.
Interventions
The end-point of this study was to reduce ventilator settings from the initial values, recorded on the day of inclusion, to the following: peak inspiratory pressure <40 cmH2O, mean airway pressure <25 cmH2O and tidal volume <10 ml/kg. Trials to achieve this goal were made on volume-controlled ventilation within the 24h before and after IVOX insertion. Comparison of the results achieved during these trials used wilcoxon test.
Results
Before IVOX implantation reduction of ventilator settings was not possible in the 6 patients, despite a non-significant increase in PaO2/FIO2 was achieved. IVOX permitted significant decrease in PaCO2 (from 60.5±15 to 52±11 mmHg;p=0.02) before any modification of the ventilatory mode. After IVOX insertion, a significant decrease of the ventilator settings was performed: peak and mean airway pressures dropped from 44±10 to 36.8±6.7;p=0.02 and from 26.3±5.6 to 22.5±3.9 cmH2O;p=0.02, respectively. Concommitantly, PaCO2 remained unchanged and PaO2/FIO2 increased significantly from 93±28 to 117±52;p=0.04. The interruption of oxygen flow on IVOX was associated with a slight decrease of the oxygen variables. Tolerance of IVOX was satisfactory. However, a significant decrease both in cardiac index and in pulmonary wedge pressures (from 4.5±1.2 to 3.4±9;p=0.03 and from 16±5 to 11±2;p=0.04, respectively) was observed.
Conclusion
Gas exchange achieved by IVOX allowed reduction of ventilator settings in 6 ARDS patients in whom previous attempts have failed. CO2 removal by the device, may explain these results. Efficacy of IVOX on arterial oxygenation was uncertain.
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References
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet II:319–323
Fowler, AA, Hamman RF, Zerbe GO, Benson KN, Hyers TM (1985) Adult respiratory distress syndrome: prognosis after onset. Am Rev Respir Dis 132:472–478
Bell RC, Coalson, JJ, Smith JD Johanson WG (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99:293–298
Montgomery AB, Stager, MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 132:485–489
Glauser FL, Crystal Polatty R, Sessler CN (1988) Worsening oxygenation in the mechanically ventilated patient. Causes, mechanisms, and early detection. Am Rev Respir Dis 138:458–465
Pingleton SK (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137:1463–1493
Gattinoni L, Pesenti A, Bombino M et al (1988) Relationship between lung computed tomographic density, gas exchange and PEEP in acute respiratory failure. Anesthesiology 69:824–832
Marini JJ (1990) Lung mechanics in the adult respiratory distress syndrome: recent conceptual advances and implications for management. Clin Chest Med 11:673–690
Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds H et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA 242:2193–2196
Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886
Mortensen JD (1987) An intravenacaval blood gas exchange device: a preliminary report. Trans Am Soc Artif Intern Organs 33: 570–573
Cox CS, Zwischenberger JB, Traber LD, Traber DL, Herndon DN (1991) Use of an intravascular oxygenator/carbon dioxide removal device in an ovine smoke inhalation injury model. ASAIO Trans 37:M411-M413
Conrad SA, Eggerstedt JM, Morris VF, Romero MD (1993) Prolonged intracorporeal support of gas exchange with an intravenacaval oxygenator. Chest 103:158–161
High KM, Snider MT Richard R, Russell GB et al (1992) Clinical trials of an intravenous oxygenator in patients with adult respiratory distress syndrome. Anesthesiology 77:856–863
Kallis P, Al-Saady NM Bennett D, Treasure T (1991) Clinical use of intravascular oxygenation. Lancet 337:549
Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723
Matamis D, Lemaire F, Harf A, Brun-Buisson C, Ansquer JC, Atlan G (1984) Total respiratory pressure volume curves in the adult respiratory distress syndrome. Chest 86:58–66
Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute respiratory failure. N Engl J Med 292:284–289
Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D et al (1983) Simplified acute physiological score for intensive care patients. Lancet II:741
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute system-organ failure. Ann Surg 149:347–351
Andersen JB (1987) Inverse I:E ratio ventilation with pressure control in catastrophic lung diesease in adults. Intensive Care World 4:21–23
Gurevitch MJ, Van Dyke J, Young ES, Jackson K (1986) Improved oxygenation and lower peak airway pressure in severe adult respiratory distress syndrome. Chest 89:211–213
Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16:372–377
Marini J, Kelsen SG (1992) Re-targeting ventilatory objectives in adult respiratory distress syndrome. Am Rev Respir Dis 146:2–3
Tsuno K, Prato P, Kolobow T (1990) Acute lung injury from mechanical ventilation at moderately high airway pressures. J Appl Physiol 69:956–961
Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Am Rev Respir Dis 137:1159–1164
Chevalier JY, Durandy Y, Batisse A, Mathe JC, Costil JC (1990) Preliminary reports: extracorporeal lung support for neonatal acute respiratory failure. Lancet 335:1364–1366
Brunet F, Belghith M, Mira JP, Lanore JJ, Vaxelaire JF, Dall'ava Santucci J, Dhainaut JF (1993) ECCO2R-LFPPV improves arterial oxygenation while reducing risk of pulmonary barotrauma in patients with ARDS. Chest 104:889–898
Bagley B, Henrie J, Froerer C, Brohamer J, Burkart J, Mortensen JD (1991) Quantitative gas transfer into and out of circulating venous blood by means of an intravascular oxygenator. ASAIO Trans 37:M413-M415
Schuller D, Mitchell JP, Calandrino FS, Schuster DP (1991) Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome? Chest 100:1068–1075
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Mira, J.P., Brunet, F., Belghith, M. et al. Reduction of ventilator settings allowed by intravenous oxygenator (IVOX) in ARDS patients. Intensive Care Med 21, 11–17 (1995). https://doi.org/10.1007/BF02425148
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DOI: https://doi.org/10.1007/BF02425148