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Oxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach.
- Source :
-
Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2019 May 13; Vol. 31 (2), pp. 113-121. Date of Electronic Publication: 2019 May 13. - Publication Year :
- 2019
-
Abstract
- Objective: To describe (1) the energy transfer from the ventilator to the lungs, (2) the match between venous-venous extracorporeal membrane oxygenation (ECMO) oxygen transfer and patient oxygen consumption (VO2), (3) carbon dioxide removal with ECMO, and (4) the potential effect of systemic venous oxygenation on pulmonary artery pressure.<br />Methods: Mathematical modeling approach with hypothetical scenarios using computer simulation.<br />Results: The transition from protective ventilation to ultraprotective ventilation in a patient with severe acute respiratory distress syndrome and a static respiratory compliance of 20mL/cm H2O reduced the energy transfer from the ventilator to the lungs from 35.3 to 2.6 joules/minute. A hypothetical patient, hyperdynamic and slightly anemic with VO2 = 200mL/minute, can reach an arterial oxygen saturation of 80%, while maintaining the match between the oxygen transfer by ECMO and the VO2 of the patient. Carbon dioxide is easily removed, and normal PaCO2 is easily reached. Venous blood oxygenation through the ECMO circuit may drive the PO2 stimulus of pulmonary hypoxic vasoconstriction to normal values.<br />Conclusion: Ultraprotective ventilation largely reduces the energy transfer from the ventilator to the lungs. Severe hypoxemia on venous-venous-ECMO support may occur despite the matching between the oxygen transfer by ECMO and the VO2 of the patient. The normal range of PaCO2 is easy to reach. Venous-venous-ECMO support potentially relieves hypoxic pulmonary vasoconstriction.
- Subjects :
- Adult
Carbon Dioxide metabolism
Computer Simulation
Energy Transfer
Female
Humans
Hypertension, Pulmonary physiopathology
Lung metabolism
Lung pathology
Oxygen Consumption
Pulmonary Gas Exchange
Extracorporeal Membrane Oxygenation methods
Models, Theoretical
Oxygen metabolism
Respiratory Distress Syndrome therapy
Subjects
Details
- Language :
- Portuguese; English
- ISSN :
- 1982-4335
- Volume :
- 31
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Revista Brasileira de terapia intensiva
- Publication Type :
- Academic Journal
- Accession number :
- 31090854
- Full Text :
- https://doi.org/10.5935/0103-507X.20190018