The artificial placenta: Continued lung development during extracorporeal support in a preterm lamb model.
J Pediatr Surg
; 53(10): 1896-1903, 2018 Oct.
Article
em En
| MEDLINE
| ID: mdl-29960740
ABSTRACT
PURPOSE:
An artificial placenta (AP) utilizing extracorporeal life support (ECLS) could avoid the harm of mechanical ventilation (MV) while allowing the lungs to develop.METHODS:
AP lambs (nâ¯=â¯5) were delivered at 118â¯days gestational age (GA; termâ¯=â¯145â¯days) and placed on venovenous ECLS (VV-ECLS) with jugular drainage and umbilical vein reinfusion. Lungs remained fluid-filled. After 10â¯days, lambs were ventilated. MV control lambs were delivered at 118 ("early MV"; nâ¯=â¯5) or 128â¯days ("late MV"; nâ¯=â¯5), and ventilated. Compliance and oxygenation index (OI) were calculated. After sacrifice, lungs were procured and H&E-stained slides scored for lung injury. Slides were also immunostained for PDGFR-α and α-actin; alveolar development was quantified by the area fraction of alveolar septal tips staining double-positive for both markers.RESULTS:
Compliance of AP lambs was 2.79⯱â¯0.81 Cdyn compared to 0.83⯱â¯0.19 and 3.04⯱â¯0.99 for early and late MV, respectively. OI in AP lambs was lower than early MV lambs (6.20⯱â¯2.10 vs. 36.8⯱â¯16.8) and lung injury lower as well (1.8⯱â¯1.6 vs. 6.0⯱â¯1.2). Double-positive area fractions were higher in AP lambs (0.012⯱â¯0.003) than early (0.003⯱â¯0.0005) and late (0.004⯱â¯0.002) MV controls.CONCLUSIONS:
Lung development continues and lungs are protected from injury during AP support relative to mechanical ventilation. LEVEL OF EVIDENCE n/a (basic/translational science).Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Órgãos Artificiais
/
Oxigenação por Membrana Extracorpórea
/
Nascimento Prematuro
/
Pulmão
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article