An Update on Interventional Lung Assist Devices and Their Role in Acute Respiratory Distress Syndrome

Mach, Marc-Alexander von; Kaes, J.; Omogbehin, B; Sagoschen, Ingo; Wiechelt, Jascha; Kaiser, Kristina; Sauer, Oliver; Weilemann, L. S.

doi:10.1007/s00408-005-2577-9

Cited by 20 publications

(3 citation statements)

References 33 publications

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“…Although extracorporeal and intravascular membrane systems can be used to artificially oxygenate the blood, these devices are typically only used as an adjunct to the most common and effective treatment for ALI/ARDS, mechanical ventilation (Golob et al, 2001;Bein et al, 2006;von Mach et al, 2006). Historically, the primary goal of various ventilation techniques was to restore adequate blood oxygenation by recruiting a majority of the unventilated regions.…”

Section: Ventilation Induced Lung Injury (Vili)mentioning

confidence: 99%

Biomechanics of liquid–epithelium interactions in pulmonary airways

Ghadiali

Gaver

2008

Respiratory Physiology & Neurobiology

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The delicate structure of the lung epithelium makes it susceptible to surface tension induced injury. For example, the cyclic reopening of collapsed and/or fluid-filled airways during the ventilation of injured lungs generates hydrodynamic forces that further damage the epithelium and exacerbate lung injury. The interactions responsible for epithelial injury during airway reopening are fundamentally multiscale, since air-liquid interfacial dynamics affect global lung mechanics, while surface tension forces operate at the molecular and cellular scales. This article will review the current state-of-knowledge regarding the effect of surface tension forces on (a) the mechanics of airway reopening and (b) epithelial cell injury. Due to the complex nature of the liquid-epithelium system, a combination of computational and experimental techniques are being used to elucidate the mechanisms of surface-tension induced lung injury. Continued research is leading to an integrated understanding of the biomechanical and biological interactions responsible for cellular injury during airway reopening. This information may lead to novel therapies that minimize ventilation induced lung injury.

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Section: Ventilation Induced Lung Injury (Vili)mentioning

confidence: 99%

Biomechanics of liquid–epithelium interactions in pulmonary airways

Ghadiali

Gaver

2008

Respiratory Physiology & Neurobiology

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“…In addition, although extracorporeal and intravascular membrane systems can be used to artificially oxygenate the blood, these devices can only be used as an adjunct to mechanical ventilation in patients with ALI. 13,14 Since mortality rates for ALI/ARDS are very high (~30%) and since mechanical ventilation is required for survival in these patients, the development of improved ventilation protocols or other treatments for ALI is a major public health issue. As a result, there is an increasing need to better understand the pathophysiological, biomechanical, and immunological mechanisms responsible for VILI.…”

Section: Introductionmentioning

confidence: 99%

Role of Airway Recruitment and Derecruitment in Lung Injury

Ghadiali

Huang

2011

Crit Rev Biomed Eng

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The mechanical forces generated during the ventilation of patients with acute lung injury causes significant lung damage and inflammation. Low-volume ventilation protocols are commonly used to prevent stretch-related injury that occurs at high lung volumes. However, the cyclic closure and reopening of pulmonary airways at low lung volumes, i.e., derecruitment and recruitment, also causes significant lung damage and inflammation. In this review, we provide an overview of how biomedical engineering techniques are being used to elucidate the complex physiological and biomechanical mechanisms responsible for cellular injury during recruitment/derecruitment. We focus on the development of multiscale, multiphysics computational models of cell deformation and injury during airway reopening. These models, and the corresponding in vitro experiments, have been used to both elucidate the basic mechanisms responsible for recruitment/derecruitment injury and to develop alternative therapies that make the epithelium more resistant to injury. For example, models and experiments indicate that fluidization of the cytoskeleton is cytoprotective and that changes in cytoskeletal structure and cell mechanics can be used to mitigate the mechanotransduction of oscillatory pressure into inflammatory signaling. The continued application of biomedical engineering techniques to the problem of recruitment/derecruitment injury may therefore lead to novel and more effective therapies.

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“…The iLA has been shown to reduce CO2 tension and could be used to avoid the need for aggressive ventilation even in the most severe cases (10)(11)(12)(13)(14)(15)(16)(17)(18). As the iLA was studied mainly in acute respiratory distress syndrome (ARDS) patients, in other clinical situations and underlying lung conditions, however, little is known about the clinical role, physiologic effects, and safety of the iLA.…”

mentioning

confidence: 99%

Physiologic Effect and Safety of the Pumpless Extracorporeal Interventional Lung Assist System in Patients With Acute Respiratory Failure—A Pilot Study

et al. 2011

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Interventional lung assist (iLA) effectively reduces CO(2) tension and permits protective lung ventilation in patients with acute respiratory distress syndrome. However, there is little experience in using iLA in acute respiratory failure from various causes and no experience for small body sizes such as Asian patients. We evaluated the physiologic effect and safety of the iLA device in patients with acute respiratory failure from various causes. We enrolled 11 consecutive patients with severe respiratory failure from various causes. Wire-enforced cannulae (13-15 Fr) were inserted under ultrasound guidance and connected to iLA. Arterial blood gas analysis, ventilator parameters, hemodynamic parameter, and adverse events were recorded serially. During the first 24h of iLA use, mean blood flow was 1.08±0.15L/min, PaCO(2) decreased from 83.9±23.4mmHg to 40.7±10.2mmHg, and PaO(2) /FiO(2) ratio increased from 110±37 to 141±74. Minute ventilation decreased from 9.4±2.5 to 6.3±1.5L/min, and peak inspiratory pressure decreased from 30.3±7.1cm H(2) O to 28.8±9.4cm H(2) O. No serious adverse events were observed during iLA use. iLA showed effective CO(2) removal, allowed for reducing the invasiveness of mechanical ventilation in patients with severe respiratory failure from various causes even using a small-sized catheter and was safe in small body-sized patients.

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An Update on Interventional Lung Assist Devices and Their Role in Acute Respiratory Distress Syndrome

Cited by 20 publications

References 33 publications

Biomechanics of liquid–epithelium interactions in pulmonary airways

Biomechanics of liquid–epithelium interactions in pulmonary airways

Role of Airway Recruitment and Derecruitment in Lung Injury

Physiologic Effect and Safety of the Pumpless Extracorporeal Interventional Lung Assist System in Patients With Acute Respiratory Failure—A Pilot Study

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