Biomedical subjects

John W McGillicuddy

Publications and source records attributed to John W McGillicuddy.

4 recordsLinked to original sources

PubMed2004

Extracorporeal life support for severe acute respiratory distress syndrome in adults.

OBJECTIVE: Severe acute respiratory distress syndrome (ARDS) is associated with a high level of mortality. Extracorporeal life support (ECLS) during severe ARDS maintains oxygen and carbon dioxide gas exchange while providing an optimal environment for recovery of pulmonary function. Since 1989, we have used a protocol-driven algorithm for treatment of severe ARDS, which includes the use of ECLS when standard therapy fails. The objective of this study was to evaluate our experience with ECLS in adult patients with severe ARDS with respect to mortality and morbidity. METHODS: We reviewed our complete experience with ELCS in adults from January 1, 1989, through December 31, 2003. Severe ARDS was defined as acute onset pulmonary failure, with bilateral infiltrates on chest x-ray, and PaO2/fraction of inspired oxygen (FiO2) ratio < or =100 or A-aDO2 >600 mm Hg despite maximal ventilator settings. The indication for ECLS was acute severe ARDS unresponsive to optimal conventional treatment. The technique of ECLS included veno-venous or veno-arterial vascular access, lung "rest" at low FiO2 and inspiratory pressure, minimal anticoagulation, and optimization of systemic oxygen delivery. RESULTS: During the study period, ECLS was used for 405 adult patients age 17 or older. Of these 405 patients, 255 were placed on ECLS for severe ARDS refractory to all other treatment. Sixty-seven percent were weaned off ECLS, and 52% survived to hospital discharge. Multivariate logistic regression analysis identified the following pre-ELCS variables as significant independent predictors of survival: (1) age (P = 0.01); (2) gender (P = 0.048); (3) pH < or =7.10 (P = 0.01); (4) PaO2/FiO2 ratio (P = 0.03); and (5) days of mechanical ventilation (P < 0.001). None of the patients who survived required permanent mechanical ventilation or supplemental oxygen therapy. CONCLUSION: Extracorporeal life support for severe ARDS in adults is a successful therapeutic option in those patients who do not respond to conventional mechanical ventilator strategies.

Adolescent↗

PubMedDate not supplied

In vitro fluid mechanical effects of thoracic artificial lung compliance.

This in vitro study sought to determine what compliance minimizes thoracic artificial lung impedance and pump power output. A pulsatile pump drove 3.0 cP glycerol through a circuit consisting of an MC3 Biolung preceded by a piston-cylinder (PC, n = 5) chamber with a variable compliance or a polyurethane (n = 4) chamber with a fixed, yet pressure-dependent, compliance. Each chamber was tested at flow rates of 1.8, 3.0, and 5.0 l/min and heart rates of 60, 75, and 100 bpm. Compliances, C, from 0-20 ml/mm Hg were tested in the PC chamber. Instantaneous pump outlet flow and pressure were acquired for determination of device zeroth and first harmonic input impedance, Z(0) and Z(1), and pump steady and pulsatile output powers, P(s) and P(p). PC chamber results indicate that Z(0), Z(1), P(s), and Pp were minimized at C > 1, 5, 0.5, and 4 ml/mm Hg, respectively. This suggests that C should be 1 ml/mm Hg at minimum and ideally 5 ml/mm Hg. The polyurethane chamber was statistically similar to the PC chamber at C = 1 ml/mm Hg when comparing Z(0) and P(s), but was statistically inferior when comparing Z(1) and P(p). The polyurethane compliance chamber, therefore, should be redesigned with greater compliance.

Artificial Organs↗

PubMedDate not supplied

Effect of artificial lung compliance on in vivo pulmonary system hemodynamics.

This study examined the effect of artificial lung compliance (C) on pulmonary system (PS) impedance and right ventricular function during in-series attachment of the MC3 Biolung in adult sheep. Compliances, C, of 0-20 ml/mm Hg were tested at the Biolung inlet. Results indicate the PS 0 harmonic input impedance modulus was not affected by C. The PS first harmonic input impedance modulus (Z1) was 10.9 +/- 3.2 mm Hg/(l/min) at C = 0 ml/mm Hg and minimized to 2.41 +/- 0.79 mm Hg/(l/min) at C > or = 0.5 ml/mm Hg. Cardiac output was 58% +/- 10% of its pre-Biolung attachment, baseline value at C = 0 ml/mm Hg and was maximized to an average of 75% +/- 11% at C > or = 0.5 ml/mm Hg. The left ventricular lateral-to-anteroposterior axis length ratio, which decreases with leftward septal shift, increased with C from 0.52 +/- 0.12 at C = 0 ml/mm Hg to 0.76 +/- 0.06 at C = 5 ml/mm Hg (p < 0.05), but decreased slightly with C at C > 5 ml/mm Hg. Therefore, the ideal C for right ventricular function is at least 0.5 ml/mm Hg and may be as high as 5 ml/mm Hg to minimize septal shift.

Animals↗

PubMedDate not supplied

Flow vectorial analysis in an artificial implantable lung.

An artificial implantable lung would be a useful device to support patients awaiting lung transplantation. A suitable device must offer low resistance and adequate gas exchange, be impermeable to plasma, and nonthrombogenic. Although plasma permeability is an intrinsic quality of the materials, the other requirements are largely a function of device geometry, particularly as it relates to fluid dynamics. Using a CAD system and the requirements of a membrane surface area of 1.5 m2 and an inlet outlet port distance of 12 cm, we designed 10 models that varied in their other dimensions. Computational fluid dynamic (CFD) software was applied to the models to determine which minimized regions of low flow velocity. A prototype built to these specifications was used in an in vivo ovine experiment to verify the CFD predictions. The prototype was placed in parallel to the native pulmonary circulation (pulmonary artery to left atrium) for 120 minutes while the activated coagulation times were kept between 110 and 120 seconds and device flow was maintained between 1.5 and 2.5 L/min. Examination of the prototype confirmed a correlation between predicted areas of low flow and thrombus formation. Although nearly identical low flow velocity conditions exist at both the inlet and outlet ports, thrombus formation occurs only near the outlet port. This finding agrees with detailed vectorial analysis, which predicts a more complex flow pattern near the outlet port. Although near the inlet port flow vectors are nearly parallel, near the outlet port flow vectors collide. This area of flow collision corresponds to the area of thrombus formation in vivo. The addition of microflow vectorial analysis to flow velocity predictions allows for improved accuracy in predicting regions at risk of thrombosis in an artificial implantable lung.

Animals↗