RESUMO
BACKGROUND: Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. MATERIAL AND METHOD: The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber. In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8~2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. RESULT: In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47+/-10 and 41+/-9 mmHg) than the nonpulsatile group I (17+/-7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222+/-8 mmHg in group 1, 739+/-35 mmHg in group 2, and 470+/-17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77+/-41 mmHg in group 1, 96+/-48 mmHg in group 2, and 97+/-25 mmHg in group 3; p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7+/-43.3, 162.8+/-113.6, 82.5+/-25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. CONCLUSION: The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.
Assuntos
Animais , Lesão Pulmonar Aguda , Aorta , Células Sanguíneas , Pressão Sanguínea , Complacência (Medida de Distensibilidade) , Circulação Extracorpórea , Oxigenação por Membrana Extracorpórea , Átrios do Coração , Insuficiência Cardíaca , Hemodinâmica , Sistemas de Manutenção da Vida , Pulmão , Modelos Teóricos , Ácido Oleico , Oxigênio , Oxigenadores de Membrana , Pressão Parcial , PlasmaRESUMO
Churg-Strauss syndrome is a rare systemic vasculitis diagnosed by the presence of any four or more of six criteria which include asthma, eosinophilia>10%, mono- or poly-neuropathy, nonfixed pulmonary infiltrate, paranasal sinus abnormality, extravascular eosinophils. In a 65 year-old-woman, multiple purpura and crusted ulcer with central necrosis were developed on the both extremities and buttocks 1 month ago. She has been suffered from asthma, sinusitis and recurrent pneumonia since ten years ago Laboratory findings showed hematuria, hypereosinophilia and hyperIgE. On the histological examination of ulcerative nodule on the right leg, leukocytoclastic vasculitis and many neutrophils and eosinophils around the cutaneous vessels were seen and the other findings were fibrinoid necrosis and thickening of vessels wall without eosinophilic granulomatous changes. Renal biopsy showed focal segmental glomerulonephritis and sclerosing nephritis. We report a rare case of Churg-Strauss syndrome with acute glomerulonephritis.