급성 호흡부전 환자에서 Pumpless Extracorporeal Interventional Lung Assist의 생리학적 효과 및 안전성
Physiologic Effect and Safety of Pumpless Extracorporeal Interventional Lung Assist in Korean Patients with Acute Respiratory Failure
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초록
Background: Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea. The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure. Methods: iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored. Results: iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change. Conclusions: iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.
Abstract
Background: Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea. The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure. Methods: iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored. Results: iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change. Conclusions: iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.
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