AVCO2R perioperative management

rapid recovery and enhanced survival

S. A. Witt, S. K. Alpard, D. J. Deyo, D. D. Harper, C. Savage, J. B. Zwischenberger

    Research output: Contribution to journalArticle

    Abstract

    Percutaneous arteriovenous CO2 removal (AVCO2R) is a simple A-V shunt for near-total CO2 removal that allows significant reductions in minute ventilation, decreased ventilator days, and increased survival in our LD40 model of ARDS. We critically reviewed our perioperative anesthetic management in this ovine smoke-burn injury model of ARDS. Sheep (n=16) require general anesthesia for the 3 steps of our protocol allowing AVCO2R outcomes studies. (1) Vascular access: 1-3 days prior to injury, 4.5-11.5 mg/kg IM ketamine and 4-5% halothane by mask for induction. Intubation, then maintenance by 1.5-2.5% halothane in 100% O2 titrated for MAP 70-95 mm Hg. Peak airway pressures were < 25 mmHg and end tidal CO2 30-40 mm Hg. (2) RDS model: Tracheostomy, then smoke insufflation (36 breaths) plus a 40% TBSA III° burn followed by mechanical ventilation. Intraop, Lactated Ringer's (LR) titrated for CVP 4-6 mm Hg. Postop, LR by Parkland formula then CVP titration. (3) AVCO2R/SHAM: When PaO2/FiO2 < 200 (48-52 hours), animals randomized to AVCO2R (n=8) or SHAM (n=8). Induction, 35% N2O and 5% isofluorane in 100% O2; maintenance 1.5-3.2% isofluorane in 100% O2 allowed exposure of the carotid artery and jugular vein. AVCO2R were cannulated (10F arterial; 14F venous) and connected to a membrane gas exchanger. SHAM received identical operative exposure without cannulation. Postop, both underwent algorithmic reduction in vent settings. All received identical heparin (ACT>300 sec) and fluid management. All sheep met criteria for RDS, survived both preps, and were standing in 0.5-5 hrs. Anesthetic time was equivalent for both groups. There were no complications attributable to anesthesia (hypotension requiring pressor support, arrythmias, or arrest). Algorithmic management protocol was followed 90% of the time. 8/8 AVCO2R and 3/8 SHAM survived the study. The absence of critical care and anesthetic related complications allows model development for independent evaluation of AVCO2R in outcomes studies.

    Original languageEnglish (US)
    Pages (from-to)181
    Number of pages1
    JournalASAIO Journal
    Volume46
    Issue number2
    StatePublished - Mar 2000

    Fingerprint

    Anesthetics
    Sheep
    Halothane
    Recovery
    Outcome Assessment (Health Care)
    Wounds and Injuries
    Ketamine
    Mechanical Ventilators
    Critical Care
    Masks
    Burns
    Intubation
    Smoke
    Hypotension
    General Anesthesia
    Blood Vessels
    Ventilation
    Cardiac Arrhythmias
    Anesthesia
    Maintenance

    ASJC Scopus subject areas

    • Biophysics
    • Bioengineering

    Cite this

    Witt, S. A., Alpard, S. K., Deyo, D. J., Harper, D. D., Savage, C., & Zwischenberger, J. B. (2000). AVCO2R perioperative management: rapid recovery and enhanced survival. ASAIO Journal, 46(2), 181.

    AVCO2R perioperative management : rapid recovery and enhanced survival. / Witt, S. A.; Alpard, S. K.; Deyo, D. J.; Harper, D. D.; Savage, C.; Zwischenberger, J. B.

    In: ASAIO Journal, Vol. 46, No. 2, 03.2000, p. 181.

    Research output: Contribution to journalArticle

    Witt, SA, Alpard, SK, Deyo, DJ, Harper, DD, Savage, C & Zwischenberger, JB 2000, 'AVCO2R perioperative management: rapid recovery and enhanced survival', ASAIO Journal, vol. 46, no. 2, pp. 181.
    Witt SA, Alpard SK, Deyo DJ, Harper DD, Savage C, Zwischenberger JB. AVCO2R perioperative management: rapid recovery and enhanced survival. ASAIO Journal. 2000 Mar;46(2):181.
    Witt, S. A. ; Alpard, S. K. ; Deyo, D. J. ; Harper, D. D. ; Savage, C. ; Zwischenberger, J. B. / AVCO2R perioperative management : rapid recovery and enhanced survival. In: ASAIO Journal. 2000 ; Vol. 46, No. 2. pp. 181.
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