Evaluation of Peritoneal Microbubble Oxygenation Therapy in a Rabbit Model of Hypoxemia

Alternative extrapulmonary oxygenation technologies are needed to treat patients suffering from severe hypoxemia refractory to mechanical ventilation. We previously demonstrated that peritoneal microbubble oxygenation (PMO), in which phospholipid-coated oxygen microbubbles (OMBs) are delivered into the peritoneal cavity, can successfully oxygenate rats suffering from a right pneumothorax. This study addressed the need to scale up the procedure to a larger animal with a splanchnic cardiac output similar to humans. Our results show that PMO therapy can double the survival time of rabbits experiencing complete tracheal occlusion from 6.6 ± 0.6 min for the saline controls to 12.2 ± 3.0 min for the bolus PMO-treated cohort. Additionally, we designed and tested a new peritoneal delivery system to circulate OMBs through the peritoneal cavity. Circulation achieved a similar survival benefit to bolus delivery under these conditions. Overall, these results support the feasibility of the PMO technology to provide extrapulmonary ventilation for rescue of severely hypoxic patients.

[1]  M. Borden,et al.  Lipid monolayer dilatational mechanics during microbubble gas exchange , 2012 .

[2]  R. Cavalli,et al.  Ultrasound-activated decafluoropentane-cored and chitosan-shelled nanodroplets for oxygen delivery to hypoxic cutaneous tissues , 2014 .

[3]  G. Bernard,et al.  ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME , 2011 .

[4]  G. Rodríguez-Laiz,et al.  Effect of intra‐abdominal pressure on hepatic microcirculation: Implications of the endothelin‐1 receptor , 2012, Journal of digestive diseases.

[5]  M. Varga Textbook of Rabbit Medicine, 2nd Edition , 2013 .

[6]  Thomas Langer,et al.  Clinical review: Extracorporeal membrane oxygenation , 2011, Critical care.

[7]  M. Flessner,et al.  Peritoneal transport physiology: insights from basic research. , 1991, Journal of the American Society of Nephrology : JASN.

[8]  J. Takala Determinants of splanchnic blood flow. , 1996, British journal of anaesthesia.

[9]  K Antonsen,et al.  Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. , 1999, American journal of respiratory and critical care medicine.

[10]  N. Mamode,et al.  Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? , 2014, Journal of Nephrology.

[11]  R. Thiagarajan,et al.  Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation , 2009, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[12]  E. Lahat,et al.  Peritoneal ventilation in rabbits: augmentation of gas exchange with cisapride. , 1996, Thorax.

[13]  S. Hawkins,et al.  Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study. , 2014, Journal of vascular and interventional radiology : JVIR.

[14]  L. Levy Physiological changes during electrical asphyxiation1 , 1971, British journal of industrial medicine.

[15]  M. Zheng,et al.  Effect of oxygenation of transperitoneal ventilation on the death time after asphyxiation in rabbits. , 2010, Minerva anestesiologica.

[16]  M. Borden,et al.  Microbubble dissolution in a multigas environment. , 2010, Langmuir : the ACS journal of surfaces and colloids.

[17]  D. Tibboel,et al.  Challenges in non-neonatal extracorporeal membrane oxygenation. , 2012, Minerva pediatrica.

[18]  J. Kheir,et al.  Phospholipid-stabilized microbubble foam for injectable oxygen delivery. , 2010, Langmuir : the ACS journal of surfaces and colloids.

[19]  W. Mitzner,et al.  Lung and vascular function during chronic severe pulmonary ischemia. , 2011, Journal of applied physiology.

[20]  F. Harcourt-Brown,et al.  ラビットメディスン : Textbook of rabbit medicine , 2001 .

[21]  J J Osborn,et al.  Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. , 1972, The New England journal of medicine.

[22]  T. Willcox,et al.  Venovenous extracorporeal membrane oxygenation in adults: practical aspects of circuits, cannulae, and procedures. , 2012, Journal of cardiothoracic and vascular anesthesia.

[23]  I. Donta,et al.  The effects of mild hypothermia on coagulation tests and haemodynamic variables in anaesthetized rabbits. , 2011, The West Indian medical journal.

[24]  S. Vasilyev,et al.  Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey. , 1995, Chest.

[25]  A. Al-Hwiesh Percutaneous Peritoneal Dialysis Catheter Insertion by a Nephrologist: A New, Simple, and Safe Technique , 2014, Peritoneal Dialysis International.

[26]  J. Chuang,et al.  A New Simplified One-Port Laparoscopic Technique for Peritoneal Dialysis Catheter Placement , 2014, Peritoneal Dialysis International.

[27]  T. Dorman,et al.  Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial , 2011 .

[28]  Charles M. Bishop The maximum oxygen consumption and aerobic scope of birds and mammals: getting to the heart of the matter , 1999, Proceedings of the Royal Society of London. Series B: Biological Sciences.

[29]  I. Boissevain [Laboratory rabbit?]. , 2003, Tijdschrift voor diergeneeskunde.

[30]  B. Ure,et al.  Haemodynamic, acid-base and blood volume changes during prolonged low pressure pneumoperitoneum in rabbits. , 2006, British journal of anaesthesia.

[31]  F. J. Herber Metabolic changes of blood and tissue gases during asphyxia. , 1948, The American journal of physiology.

[32]  C. Sprung,et al.  The epidemiology of acute respiratory failure in critically ill patients(*). , 2002, Chest.

[33]  Mark A. Suckow,et al.  The Laboratory Rabbit , 1997 .

[34]  Jin H. Lee,et al.  Markers of poor outcome in patients with acute hypoxemic respiratory failure. , 2014, Journal of critical care.

[35]  Feng Xu,et al.  Oxygen consumption by lungs with acute and chronic injury in a rabbit model , 2001, Intensive Care Medicine.

[36]  S. Davies Peritoneal dialysis—current status and future challenges , 2013, Nature Reviews Nephrology.

[37]  K. Wieczorowska-Tobis,et al.  Species-dependent topography of the peritoneum. , 1996, Advances in peritoneal dialysis. Conference on Peritoneal Dialysis.

[38]  A. Spiotta,et al.  Intracranial Hemorrhage Surgery on Patients on Mechanical Circulatory Support: A Case Series , 2011, Journal of neurosurgical anesthesiology.

[39]  T. Ishikawa,et al.  Oxygen supersaturated fluid using fine micro/nanobubbles , 2014, International journal of nanomedicine.

[40]  Mao Zhang,et al.  Therapeutic mild hypothermia improves early outcomes in rabbits subjected to traumatic uncontrolled hemorrhagic shock. , 2013, The Journal of surgical research.

[41]  S. Brett,et al.  Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review , 2014, Critical Care.

[42]  M. Borden,et al.  Lipid monolayer collapse and microbubble stability. , 2012, Advances in colloid and interface science.

[43]  Kristian Antonsen,et al.  Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland , 1999 .

[44]  P. Dayton,et al.  Theranostic Oxygen Delivery Using Ultrasound and Microbubbles , 2012, Theranostics.

[45]  O. Vainio,et al.  Some factors influencing the level of clinical sedation induced by medetomidine in rabbits. , 2002, Journal of veterinary pharmacology and therapeutics.

[46]  V. Dequattro,et al.  Gastrointestinal and Mesenteric Hemodynamic Patterns in Neurogenic Hypertensive Rabbits , 1974, Circulation research.

[47]  R. Ohye,et al.  Awake extracorporeal membrane oxygenation for management of critical distal tracheal obstruction , 2010, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[48]  Nathan D. Legband,et al.  Systemic oxygen delivery by peritoneal perfusion of oxygen microbubbles , 2014, Biomaterials.