1
|
Cui W, Wang T, Xu Z, Liu J, Simakov S, Liang F. A numerical study of the hemodynamic behavior and gas transport in cardiovascular systems with severe cardiac or cardiopulmonary failure supported by venoarterial extracorporeal membrane oxygenation. Front Bioeng Biotechnol 2023; 11:1177325. [PMID: 37229493 PMCID: PMC10203410 DOI: 10.3389/fbioe.2023.1177325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been extensively demonstrated as an effective means of bridge-to-destination in the treatment of patients with severe ventricular failure or cardiopulmonary failure. However, appropriate selection of candidates and management of patients during Extracorporeal membrane oxygenation (ECMO) support remain challenging in clinical practice, due partly to insufficient understanding of the complex influences of extracorporeal membrane oxygenation support on the native cardiovascular system. In addition, questions remain as to how central and peripheral venoarterial extracorporeal membrane oxygenation modalities differ with respect to their hemodynamic impact and effectiveness of compensatory oxygen supply to end-organs. In this work, we developed a computational model to quantitatively address the hemodynamic interaction between the extracorporeal membrane oxygenation and cardiovascular systems and associated gas transport. Model-based numerical simulations were performed for cardiovascular systems with severe cardiac or cardiopulmonary failure and supported by central or peripheral venoarterial extracorporeal membrane oxygenation. Obtained results revealed that: 1) central and peripheral venoarterial extracorporeal membrane oxygenation modalities had a comparable capacity for elevating arterial blood pressure and delivering oxygenated blood to important organs/tissues, but induced differential changes of blood flow waveforms in some arteries; 2) increasing the rotation speed of extracorporeal membrane oxygenation pump (ω) could effectively improve arterial blood oxygenation, with the efficiency being especially high when ω was low and cardiopulmonary failure was severe; 3) blood oxygen indices (i.e., oxygen saturation and partial pressure) monitored at the right radial artery could be taken as surrogates for diagnosing potential hypoxemia in other arteries irrespective of the modality of extracorporeal membrane oxygenation; and 4) Left ventricular (LV) overloading could occur when ω was high, but the threshold of ω for inducing clinically significant left ventricular overloading depended strongly on the residual cardiac function. In summary, the study demonstrated the differential hemodynamic influences while comparable oxygen delivery performance of the central and peripheral venoarterial extracorporeal membrane oxygenation modalities in the management of patients with severe cardiac or cardiopulmonary failure and elucidated how the status of arterial blood oxygenation and severity of left ventricular overloading change in response to variations in ω. These model-based findings may serve as theoretical references for guiding the application of venoarterial extracorporeal membrane oxygenation or interpreting in vivo measurements in clinical practice.
Collapse
Affiliation(s)
- Wenhao Cui
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tianqi Wang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhuoming Xu
- Cardiac Intensive Care Unit, Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sergey Simakov
- Department of Computational Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences, Moscow, Russia
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
2
|
L'Her E, Jaber S, Verzilli D, Jacob C, Huiban B, Futier E, Kerforne T, Pateau V, Bouchard PA, Consigny M, Lellouche F. Automated closed-loop versus standard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study. Eur Respir J 2020; 57:13993003.00182-2020. [DOI: 10.1183/13993003.00182-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/17/2020] [Indexed: 11/05/2022]
Abstract
IntroductionHypoxaemia and hyperoxaemia may occur after surgery, with related complications. This multicentre randomised trial evaluated the impact of automated closed-loop oxygen administration after high-risk abdominal or thoracic surgeries in terms of optimising the oxygen saturation measured by pulse oximetry time within target range.MethodsAfter extubation, patients with an intermediate to high risk of post-operative pulmonary complications were randomised to “standard” or “automated” closed-loop oxygen administration. The primary outcome was the percentage of time within the oxygenation range, during a 3-day frame. The secondary outcomes were the time with hypoxaemia and hyperoxaemia under oxygen.ResultsAmong the 200 patients, time within range was higher in the automated group, both initially (≤3 h; 91.4±13.7% versus 40.2±35.1% of time, difference +51.0% (95% CI −42.8–59.2%); p<0.0001) and during the 3-day period (94.0±11.3% versus 62.1±23.3% of time, difference +31.9% (95% CI 26.3–37.4%); p<0.0001). Periods of hypoxaemia were reduced in the automated group (≤3 days; 32.6±57.8 min (1.2±1.9%) versus 370.5±594.3 min (5.0±11.2%), difference −10.2% (95% CI −13.9–−6.6%); p<0.0001), as well as hyperoxaemia under oxygen (≤3 days; 5.1±10.9 min (4.8±11.2%) versus 177.9±277.2 min (27.0±23.8%), difference −22.0% (95% CI −27.6–−16.4%); p<0.0001). Kaplan–Meier analysis depicted a significant difference in terms of hypoxaemia (p=0.01) and severe hypoxaemia (p=0.0003) occurrence between groups in favour of the automated group. 25 patients experienced hypoxaemia for >10% of the entire monitoring time during the 3 days within the standard group, as compared to the automated group (p<0.0001).ConclusionAutomated closed-loop oxygen administration promotes greater time within the oxygenation target, as compared to standard manual administration, thus reducing the occurrence of hypoxaemia and hyperoxaemia.
Collapse
|
3
|
L’her E, Jaber S, Verzilli D, Jacob C, Huiban B, Futier E, Kerforne T, Pateau V, Bouchard PA, Gouillou M, Nowak E, Lellouche F. Automated oxygen administration versus conventional oxygen therapy after major abdominal or thoracic surgery: study protocol for an international multicentre randomised controlled study. BMJ Open 2019; 9:e023833. [PMID: 30782716 PMCID: PMC6340445 DOI: 10.1136/bmjopen-2018-023833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Hypoxemia and hyperoxia may occur after surgery with potential related complications. The FreeO2 PostOp trial is a prospective, multicentre, randomised controlled trial that evaluates the clinical impact of automated O2 administration versus conventional O2 therapy after major abdominal or thoracic surgeries. The study is powered to demonstrate benefits of automated oxygen titration and weaning in term of oxygenation, which is an important surrogate for complications after such interventions. METHODS AND ANALYSIS After extubation, patients are randomly assigned to the Standard (manual O2 administration) or FreeO2 group (automated closed-loop O2 administration). Stratification is performed for the study centre and a medical history of chronic obstructive pulmonary disease (COPD). Primary outcome is the percentage of time spent in the target zone of oxygen saturation, during a 3-day time frame. In both groups, patients will benefit from continuous oximetry recordings. The target zone of oxygen saturation is SpO2=88%-92% for patients with COPD and 92%-96% for patients without COPD. Secondary outcomes are the nursing workload assessed by the number of manual O2 flow adjustments, the time spent with severe desaturation (SpO2 <85%) and hyperoxia area (SpO2 >98%), the time spent in a hyperoxia area (SpO2 >98%), the VO2, the duration of oxygen administration during hospitalisation, the frequency of use of mechanical ventilation (invasive or non-invasive), the duration of the postrecovery room stay, the hospitalisation length of stay and the survival rate. ETHICS AND DISSEMINATION The FreeO2 PostOp study is conducted in accordance with the declaration of Helsinki and was registered on 11 September 2015 (http://www.clinicaltrials.gov). First patient inclusion was performed on 14 January 2016. The results of the study will be presented at academic conferences and submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02546830.
Collapse
Affiliation(s)
- Erwan L’her
- Medical Intensive Care, CHRU de Brest—La Cavale Blanche, Brest, France
- LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
| | - Samir Jaber
- Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, Montpellier, France
| | - Daniel Verzilli
- Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, Montpellier, France
| | - Christophe Jacob
- Anesthesiology Department, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Brigitte Huiban
- Anesthesiology Department, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Emmanuel Futier
- Anesthesiology Department, Hôpital Estaing, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Kerforne
- Anesthesiology Department, CHU de Poitiers, Poitiers Cedex, France
| | - Victoire Pateau
- LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
- R&D, Oxynov Inc., Technopôle Brest Iroise, Plouzané, France
| | - Pierre-Alexandre Bouchard
- Research laboratory, Centre de recherche de l’Institut de Cardiologie et de Pneumologie de Québec, Québec, France
| | - Maellen Gouillou
- Centre d’Investigation Clinique CIC INSERM 1412, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Emmanuel Nowak
- Centre d’Investigation Clinique CIC INSERM 1412, CHRU de Brest—La Cavale Blanche, Brest, France
| | - François Lellouche
- Research laboratory, Centre de recherche de l’Institut de Cardiologie et de Pneumologie de Québec, Québec, France
| |
Collapse
|
4
|
Rodrigues WC, de Melo WM, de Almeida RS, Pardo-Kaba SC, Sonoda CK, Shinohara EH. Submental Intubation in Cases of Panfacial Fractures: A Retrospective Study. Anesth Prog 2018; 64:153-161. [PMID: 28858549 DOI: 10.2344/anpr-64-04-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Surgical treatment of panfacial fractures usually requires intraoperative temporary occlusion of the teeth and simultaneous access to the nasal pyramid. In such cases, the standard method of airway management is to perform a tracheostomy, but this may be associated with a significant number of perioperative and late complications. This study aimed to determine if submental endotracheal intubation (SEI) is a viable alternative to tracheostomy, especially when short-term postoperative control of the airway is foreseen. This was an observational retrospective study, carried out between 2012 and 2014, which involved 32 consecutive patients who sustained panfacial fractures and were surgically treated during a 3-year period in a level I trauma center hospital. Only those who required SEI were included in the sample. Four cases were excluded because of incomplete registries, follow-up period less than 4 months after hospital discharge, or other unrelated complications. The medical charts of all patients involved in the sample were carefully reviewed in order to qualify and quantify perioperative and postoperative complications related to anesthetic management. We hypothesized that SEI would not interfere with the surgical procedures and would present less morbidity and reduced complication rates. Twenty-eight patients, 24 male and 4 female, met all the inclusion criteria. The mean age was 29.5 ± 9.05 years (range, 18-56 years). The mean duration time of surgery was 8.07 ± 4.0 hours (range, 4-16 hours). There were no perioperative complications. Postoperatively, only 1 patient (3.57%) experienced a cutaneous infection at the submental region, which was easily treated. Additionally, only 1 case (3.57%) of hypertrophic scar was reported. SEI appears to be a safe, simple, and effective technique of immediate perioperative airway management in selected cases of panfacial fractures.
Collapse
Affiliation(s)
- Willian Caetano Rodrigues
- PhD Student in Oral & Maxillofacial Surgery Program, Department of Diagnostic and Surgery, Araraquara School of Dentistry, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araraquara, São Paulo, Brazil
| | - Willian Morais de Melo
- PhD in Oral & Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Araçatuba Dental School, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araçatuba, São Paulo, Brazil
| | - Rafael Santiago de Almeida
- PhD Student in Oral & Maxillofacial Surgery Program, Department of Surgery and Integrated Clinic, Araçatuba Dental School, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araçatuba, São Paulo, Brazil
| | - Shajadi Carlos Pardo-Kaba
- Professor at Oral & Maxillofacial Surgery Resident Program, Division of Oral & Maxillofacial Surgery, Vila Penteado Hospital, SUS/SP, São Paulo, Brazil
| | - Celso Koogi Sonoda
- Professor, Department of Surgery and Integrated Clinic, Araçatuba Dental School, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araçatuba, São Paulo, Brazil
| | - Elio Hitoshi Shinohara
- Professor, Department of Surgery and Integrated Clinic, Araçatuba Dental School, Univ Estadual Paulista Júlio de Mesquita Filho - UNESP, Araçatuba, São Paulo, Brazil
| |
Collapse
|
5
|
Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017). Anesth Prog 2018; 65:e1-e18. [PMID: 30702348 PMCID: PMC6318731 DOI: 10.2344/anpr-65-04-15w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
6
|
Ma YL, Zhu X, Rivera PM, Tøien Ø, Barnes BM, LaManna JC, Smith MA, Drew KL. Absence of cellular stress in brain after hypoxia induced by arousal from hibernation in Arctic ground squirrels. Am J Physiol Regul Integr Comp Physiol 2005; 289:R1297-306. [PMID: 15976308 DOI: 10.1152/ajpregu.00260.2005] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although hypoxia tolerance in heterothermic mammals is well established, it is unclear whether the adaptive significance stems from hypoxia or other cellular challenge associated with euthermy, hibernation, or arousal. In the present study, blood gases, hemoglobin O2 saturation (S(O2), and indexes of cellular and physiological stress were measured during hibernation and euthermy and after arousal thermogenesis. Results show that arterial O2 tension (Pa(O2)) and S(O2) are severely diminished during arousal and that hypoxia-inducible factor (HIF)-1alpha accumulates in brain. Despite evidence of hypoxia, neither cellular nor oxidative stress, as indicated by inducible nitric oxide synthase (iNOS) levels and oxidative modification of biomolecules, was observed during late arousal from hibernation. Compared with rats, hibernating Arctic ground squirrels (Spermophilus parryii) are well oxygenated with no evidence of cellular stress, inflammatory response, neuronal pathology, or oxidative modification following the period of high metabolic demand necessary for arousal. In contrast, euthermic Arctic ground squirrels experience mild, chronic hypoxia with low S(O2) and accumulation of HIF-1alpha and iNOS and demonstrate the greatest degree of cellular stress in brain. These results suggest that Arctic ground squirrels experience and tolerate endogenous hypoxia during euthermy and arousal.
Collapse
Affiliation(s)
- Yi Long Ma
- Institute of Arctic Biology, Alaska Basic Neuroscience Program, Box 757000, 902 N. Koyukuk Dr., Irving I Rm. 311, University of Alaska Fairbanks, Fairbanks, AK 99775-7000, USA
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Affiliation(s)
- D K Rose
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario
| |
Collapse
|
8
|
Canet J. Oxygen Therapy in the Postanesthesia Care Unit. Anesth Analg 1995. [DOI: 10.1213/00000539-199512000-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|