A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support

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• 作者：Alberto Zanella ; MD^a ; ^b ; ^{zanella.alb@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Domenico Salerno ; PhD^c ; Vittorio Scaravilli ; MD^c ; Marco Giani ; MD^d ; Luigi Castagna ; MD^d ; Federico Magni ; MD^c ; Eleonora Carlesso ; MSc^b ; Paolo Cadringher ; MSc^a ; Michela Bombino ; MD^d ; Giacomo Grasselli ; MD^a ; Nicolò ; Patroniti ; MD^c ; ^d ; Antonio Pesenti ; MD^a ; ^b
• 关键词：Extracorporeal circulation ; Extracorporeal membrane oxygenation ; Oxygen consumption ; Blood circulation ; Cardiac output ; Theoretical models
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：178-186
• 全文大小：1372 K

文摘

To develop a mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation (vv-ECMO).

Material and methods

Total oxygen consumption, cardiac output, blood flow, recirculation, intrapulmonary shunt, hemoglobin, natural lung, and membrane lung oxygen fractions were chosen as inputs. Content, partial pressure, and hemoglobin saturation of oxygen in arterial, venous, pulmonary, and extracorporeal blood were outputs. To assess accuracy and predictive power of the model, we retrospectively analyzed data of 25 vv-ECMO patients. We compiled 2 software (with numerical, 2D and 3D graphical outputs) to study the impact of each variable on oxygenation.

Results

The model showed high accuracy and predictive power. Raising blood flow and oxygen fraction to the membrane lung or reducing total oxygen consumption improves arterial and venous oxygenation, especially in severe cases; raising oxygen fraction to the natural lung improves oxygenation only in milder cases; raising hemoglobin always improves oxygenation, especially in the venous district; recirculation fraction severely impairs oxygenation. In severely ill patients, increasing cardiac output worsens arterial oxygenation but enhances venous oxygenation. Oxygen saturation of ECMO inlet is critical to evaluate the appropriateness of oxygen delivery.

Conclusions

The model with the software can be a useful teaching tool and a valuable decision-making aid for the management of hypoxic patients supported by vv-ECMO.