Determinants of Oxygen and Carbon Dioxide Transfer during Extracorporeal Membrane Oxygenation in an Experimental Model of Multiple Organ Dysfunction Syndrome
Carregando...
Citações na Scopus
44
Tipo de produção
article
Data de publicação
2013
Título da Revista
ISSN da Revista
Título do Volume
Editora
PUBLIC LIBRARY SCIENCE
Autores
SILVA, Debora Prudencio e
FRIEDRICH, Natalia
SCHETTINO, Guilherme
Citação
PLOS ONE, v.8, n.1, article ID e54954, 11p, 2013
Resumo
Extracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, p<0.001) and a negative association with premembrane PaCO2 (slope = -0.96, P = 0.001) and SatO(2) (slope = 21.7, p<0.001). Carbon dioxide transfer had a positive association with blood flow (slope = 17, p<0.001), gas flow (slope = 33, p<0.001), pre-membrane PaCO2 (slope = 1.2, p<0.001) and a negative association with the hemoglobin (slope = -3.478, P = 0.042). We found an increase in pH in the baseline from 7.50[7.46,7.54] to 7.60[7.55,7.65] (p<0.001), and during the MOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (p<0.001). Likewise, the PCO2 fell in the baseline from 35 [32,39] to 25 [22,27] mmHg (p<0.001), and during the MOF from 59 [47,91] to 34 [28,45] mmHg (p<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO(2) and CO2, while carbon dioxide transfer was affected by the gas flow, pre-membrane CO2 and hemoglobin.
Palavras-chave
Referências
- Almeida JRD, 2010, J TRAUMA, V69, P375, DOI 10.1097/TA.0b013e3181e12b3a
- Bosticardo GM, 2010, NEPHROL DIAL TRANSPL, V25, P3458, DOI 10.1093/ndt/gfq422
- Chauhan Sandeep, 2011, Ann Card Anaesth, V14, P218, DOI 10.4103/0971-9784.84030
- Davies A, 2009, JAMA-J AM MED ASSOC, V302, P1888
- de Azevedo Luciano Cesar Pontes, 2007, Clinics (Sao Paulo), V62, P491, DOI 10.1590/S1807-59322007000400017
- DOUGLAS AR, 1988, J APPL PHYSIOL, V65, P473
- FIGGE J, 1991, J LAB CLIN MED, V117, P453
- Kellum JA, 1998, SHOCK, V9, P364, DOI 10.1097/00024382-199805000-00009
- KOLOBOW T, 1977, T AM SOC ART INT ORG, V23, P17
- MELIONES JN, 1991, CRIT CARE MED, V19, P1247, DOI 10.1097/00003246-199110000-00006
- Morgan T John, 2009, Clin Biochem Rev, V30, P41
- MULHAUSE.RO, 1970, CIRCULATION, V42, P195
- Nguyen MK, 2006, J APPL PHYSIOL, V100, P1293, DOI 10.1152/jappalphysiol.01274.2005
- Noah MA, 2011, JAMA
- Patroniti N, 2011, INTENS CARE MED, V37, P1447, DOI 10.1007/s00134-011-2301-6
- Peek GJ, 2009, LANCET, V374, P1351, DOI 10.1016/S0140-6736(09)61069-2
- R Development Core Team, 2009, R LANG ENV STAT COMP
- RIGGS TE, 1973, J CLIN INVEST, V52, P2660, DOI 10.1172/JCI107459
- Rosario AL, 2011, SHOCK
- Sidebotham D, 2009, J CARDIOTHORAC VASC
- SIGGAARDANDERSEN O, 1977, SCAND J CLIN LAB INV, V37, P15, DOI 10.3109/00365517709098927
- Zimmermann AK, 2007, J BIOMED MATER RES B, V80B, P433, DOI 10.1002/jbm.b.30614