We have applied high peak airway pressure (50 cm H2O) positive pressure ventilation to healthy anesthetized and sedated sheep while monitoring changes in total static lung compliance (TSLC), functional residual capacity (FRC), and arterial blood gases. Following some 12-48 hours of continuous mechanical ventilation, there was marked reduction in TSLC, FRC, and a severe deterioration in arterial blood gases. One group of animals was then randomized to a state of the art mechanical pulmonary ventilation management group, with best efforts made to wean to room air. All but one animal so managed died of progressive respiratory failure. In the remaining animals, high pressure mechanical pulmonary ventilation was discontinued and they were placed on continuous positive airway pressure (CPAP), and on an extracorporeal membrane lung perfusion system. Following some 24 hours of such treatment, all but one animal showed progressive improvement in arterial blood gases, and in lung function, and could be weaned from bypass. We believe mechanical pulmonary ventilation at elevated peak airway pressures is a major cause of clinical morbidity and mortality. The novel application of the extracorporeal perfusion system with the membrane artificial lung is likely to find rapid clinical application.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Intramural Research (Z01)
Project #
1Z01HL001404-18
Application #
3966573
Study Section
Project Start
Project End
Budget Start
Budget End
Support Year
18
Fiscal Year
1986
Total Cost
Indirect Cost
Name
U.S. National Heart Lung and Blood Inst
Department
Type
DUNS #
City
State
Country
United States
Zip Code
Rezoagli, Emanuele; Zanella, Alberto; Cressoni, Massimo et al. (2017) Pathogenic Link Between Postextubation Pneumonia and Ventilator-Associated Pneumonia: An Experimental Study. Anesth Analg 124:1339-1346
Li Bassi, Gianluigi; Berra, Lorenzo; Kolobow, Theodor (2007) Silver-coated endotracheal tubes: is the bactericidal effect time limited? Crit Care Med 35:986;author reply 987
Parravicini, Elvira; Baccarelli, Andrea; Wung, Jen Tien et al. (2007) A comparison of a new, ultrathin-walled two-stage twin endotracheal tube and a conventional endotracheal tube in very premature infants with respiratory distress syndrome: a pilot study. Am J Perinatol 24:117-22
Li Bassi, Gianluigi; Curto, Francesco; Zanella, Alberto et al. (2007) A 72-hour study to test the efficacy and safety of the ""Mucus Slurper"" in mechanically ventilated sheep. Crit Care Med 35:906-11
Kolobow, Theodor; Berra, Lorenzo; Li Bassi, Gianluigi et al. (2005) Novel system for complete removal of secretions within the endotracheal tube: the Mucus Shaver. Anesthesiology 102:1063-5
Berra, Lorenzo; De Marchi, Lorenzo; Panigada, Mauro et al. (2004) Evaluation of continuous aspiration of subglottic secretion in an in vivo study. Crit Care Med 32:2071-8
Kolobow, Theodor (2004) The artificial lung: the past. A personal retrospective. ASAIO J 50:xliii-xlviii
Kolobow, Theodor; Berra, Lorenzo; DeMarchi, Lorenzo et al. (2004) Ultrathin-wall, two-stage, twin endotracheal tube: a tracheal tube with minimal resistance and minimal dead space for use in newborn and infant patients. Pediatr Crit Care Med 5:379-83
Berra, Lorenzo; De Marchi, Lorenzo; Yu, Zu-Xi et al. (2004) Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Anesthesiology 100:1446-56
Kolobow, Theodor (2004) Volutrauma, barotrauma, and ventilator-induced lung injury: lessons learned from the animal research laboratory. Crit Care Med 32:1961-2

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