Abstract:
PURPOSE:Acute respiratory distress syndrome, with the need for invasive mechanical ventilation (MV) remains a major cause of neonatal mortality and morbidity. Although venovenous extracorporeal lung support (VV-ECLS) has become a standard of care procedure in neonatal patients with acute pulmonary failure there are no reports regarding the use of a double-lumen cannula for extracorporeal minimal invasive lung support via the umbilical vein. METHODS:A neonatal lamb model was used (n = 3). Umbilical vein was cannulated with a double-lumen catheter allowing venovenous extracorporeal gas exchange. Cannula was positioned with its tip in the right atrium. VV-ECLS was started and ventilation was stopped. Providing oxygenation and CO2 removal solely through VV-ECLS hemodynamics, blood gases were measured. RESULTS:Total VV-ECLS without MV was applied to all three neonatal lambs. Time on venovenous ECLS was 60, 120 and 120 min. Initial pCO2 was 60, 56 and 65 mmHg compared to 31, 32 and 32 mmHg at the end of VV-ECLS. Initial pO2 was 30, 27 and 26 mmHg compared to 22, 19 and 23 mmHg. Initial lactate was 5, 10 and 3.7 mmol/l compared to 13.3, 12.6 and 11.3 mmol/l at the end of VV-ECLS. MAP at baseline was 51, 52 and 65 mmHg compared to 36, 38 and 41 mmHg at the end of VV-ECLS. In all three lambs inotropes were admitted to maintain MAD >35 mmHg. CONCLUSION:Even without mechanical ventilation we were able to sufficiently remove pCO2 with our new minimal invasive VV-ECLS using a double-lumen catheter via the umbilical vein, supporting the idea of a lung protective strategy in neonatal acute respiratory failure. pO2 was measured 22, 19 and 23 mmHg, respectively, at the end of VV-ECLS, at least partially caused by recirculation phenomenon, which could possibly be improved by different cannula design. Inotropic support was necessary during VV-ECLS to achieve targeted MAD > 35 mmHg. While technically feasible, this new approach might allow further research in the field of extracorporeal lung support and therefore will follow the concept of a lung protective strategy in acute neonatal respiratory failure.
journal_name
Pediatr Surg Intjournal_title
Pediatric surgery internationalauthors
Schmidt F,Kuebler J,Ganter M,Jack T,Meschenmoser L,Sasse M,Boehne M,Bertram H,Beerbaum P,Koeditz Hdoi
10.1007/s00383-015-3815-8subject
Has Abstractpub_date
2016-01-01 00:00:00pages
75-82issue
1eissn
0179-0358issn
1437-9813pii
10.1007/s00383-015-3815-8journal_volume
32pub_type
杂志文章abstract::The loss of esophageal length in long-gap esophageal atresia or obliteration of the esophageal lumen due to stricture may require major operative reconstruction. A number of procedures have been developed to allow anatomic replacement of the esophagus. The gastric transposition requires a single cervical anastomosis a...
journal_title:Pediatric surgery international
pub_type: 杂志文章,评审
doi:10.1007/s00383-010-2736-9
更新日期:2010-12-01 00:00:00
abstract::A retrospective study of all cases (n = 21) of congenital lobar emphysema (CLE) treated at the Royal Hospital, Muscat, from September 1988 to August 1999 was performed. The presentation, diagnosis, treatment, and outcome are reviewed. All 21 patients were nonwhite. Thirteen had left-upper-lobe, 7 right-middle-lobe, an...
journal_title:Pediatric surgery international
pub_type: 杂志文章
doi:10.1007/s003830000506
更新日期:2001-03-01 00:00:00
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journal_title:Pediatric surgery international
pub_type: 杂志文章
doi:10.1007/s00383-013-3381-x
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journal_title:Pediatric surgery international
pub_type: 杂志文章
doi:10.1007/s003830000449
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journal_title:Pediatric surgery international
pub_type: 杂志文章
doi:10.1007/s00383-007-1961-3
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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journal_title:Pediatric surgery international
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pub_type: 杂志文章,随机对照试验
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journal_title:Pediatric surgery international
pub_type: 杂志文章
doi:
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pub_type: 杂志文章,meta分析
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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更新日期:2002-03-01 00:00:00
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:Pediatric surgery international
pub_type: 杂志文章
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更新日期:2006-11-01 00:00:00
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pub_type: 杂志文章
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