Temporary Support of the Lungs - the Artificial Lung

  • W. Federspiel
  • P. Sawzik
  • H. Borovetz
  • G. D. Reeder
  • B. G. Hattler


The adult respiratory distress syndrome (ARDS), described first by Ashbaugh and his colleagues[1] almost 30 years ago, continues to present a dilemma to the clinician, for the mortality associated with the syndrome has remained exceedingly high in spite of a better understanding of the mechanisms that contribute to this pulmonary disease process. For the patient with ARDS, maintaining gas exchange at a level consistent with survival is associated frequently with progressively increasing levels of respiratory support. The final outcome in these patients is contributed to not only by the degree of pulmonary injury, but also by the level of dysfunction in multiple other organs=. Recognizing these facts, and that any therapy for ARDS involves more than just providing a setting where the lungs have the potential for recovery, we will concentrate this discussion on new therapies with intracorporeal devices under development for the treatment of ARDS.


Inferior Vena Cava Hollow Fiber Superior Vena Cava Fiber Membrane Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ashbaugh DG, Bigelow DB, Petty TL, Kevine BE. Acute respiratory distress in adults. Lancet. 1967;2:319–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Bone RC, Balk R, Slotman G et al. Adult respiratory distress syndrome: sequence and importance of development of multiple organ failure. Chest. 1992;101:320–6.PubMedGoogle Scholar
  3. 3.
    Heironimus TW IH. Mechanical artificial ventilation: a manual for students and practitioners. Springfield: Charles C. Thomas; 1967:85–9.Google Scholar
  4. 4.
    Faulconer A Jr, Keys TK.Foundations of anesthesiology. Springfield: Charles C.Thomas; 1965.Google Scholar
  5. 5.
    Castiglioni A. A history of medicine. New York: Knopf; 1947:108–78.Google Scholar
  6. 6.
    Mushini WW. Thoracic anesthesia. Philadelphia, PA: Davis; 1963.Google Scholar
  7. 7.
    Drinker P, Shaw LA. An apparatus for the prolonged administration of artificial respiration. I. A design for adults and children. J Clin Invest. 1929;7:229.PubMedCrossRefGoogle Scholar
  8. 8.
    Engstrom CG. The clinical application of prolonged controlled ventilation. Acta Anaesth Scand. Suppl. XIII, 1963.Google Scholar
  9. 9.
    Maloney JV Jr. Elam JO, Handford SW, et al. Importance of negative pressure phase in mechanical respirators. J Am Med Assoc 1953;152:212.PubMedGoogle Scholar
  10. 10.
    Whittenberger JL. Artificial respiration. Physiol Rev. 1955;32:4.Google Scholar
  11. 11.
    Cournand A, Motley HL, Werko L, Richards DW Jr. Intermittent positive pressure breathing and cardiac output in man. Am J Physiol. 1948; 152:162.PubMedGoogle Scholar
  12. 12.
    Motley ML, Cournand A, Werko L, Drisdale DT, Himmelstein A, Richards DW Jr. Intermittent positive pressure breathing a means of administering artificial respiration in man. J Am Med Assoc. 1948; 137:3711.Google Scholar
  13. 13.
    Teplittz CC. The core pathobiology and integrated medical science of adult acute respiratory insufficiency. Surg Clin N Am. 1976;56:1091–133.Google Scholar
  14. 14.
    Boyce NW, Campbell D, Holdsworth SR. Modulation of normobaric pulmonary oxygen toxieity by hydroxyl radical inhibition. Clin Invest Med. 1987;10:316–20.PubMedGoogle Scholar
  15. 15.
    Fisher AB. Pulmonary oxygen toxicity. In: Fishman PA, editor. Pulmonary diseases and disorders. New York: McGraw-Hill;1987:2331–8.Google Scholar
  16. 16.
    Caldwell PRB, Weibel ER. Pulmonary oxygen toxicity. In: Fishman PA, editor. Pulmonary diseases and disorders. New York: McGraw-Hill; 1987:800–5.Google Scholar
  17. 17.
    Morris AH, Wallace CJ, Menlove TP. et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:295–305.PubMedGoogle Scholar
  18. 18.
    Crapo JD. Morphologic changes in pulmonary oxygen toxicity. Annu Rev Physiol. 1986;48:721–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Hansen-Glaschen JH, Lanken PN, Pietra GG, Sampson PM, Johns L, Fishman PA. Effect of 100% O2 on passage of uncharged dextrans from blood to lung lymph. J Appl Physiol. 1986;60:1797–1809.CrossRefGoogle Scholar
  20. 20.
    Zapol WM, Snider MT.Pulmonary hypertension in severe acute respiratory failure. N Engl J Med. 1977;296:476–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Vesconi S, Rossi GP, Pesenti A, Funagalli R, Gallinoni L. Pulmonary microthrombosis in severe adult respiratory distress syndrome. Crit Care Med. 1988;16:111–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Caldwell PRB, Lee WL, Schildkrout HS, Archibald ER. Changes in lung volume, diffusion capacity and blood gases in men breathing oxygen. J Appl Physiol. 1966;921:1477–83.Google Scholar
  23. 23.
    Clark JM, Lambertsen CJ. Pulmonary oxygen toxicity: a review. Pharmacol Rev. 1971;23:37–133.PubMedGoogle Scholar
  24. 24.
    Davis WB, Rennard SE, Bitterman PB, Crystal RB. Pulmonary oxygen toxicity. Early reversible changes in human alveolar structures induced by hyperoxia. N Engl J Med. 1983;309:878–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Artigas A, Carlet J. LeGall J, Castang C, Blanch L, Fernandez R. Clinical presentation, prognostic factors and outcome of ARDS in the European collaborative study (1985–1987); a preliminary report. In: Zapol W, Leniaire F. editors. Adult respiratory distress syndrome. New York: Dekker; 1991:13–63.Google Scholar
  26. 26.
    Said SI. Mechanisms of acute lung injury: methods of modulation. In: Yacoub M. editor. Annual of cardiac surgery. London: Current Science Ltd; 1989:50–55.Google Scholar
  27. 27.
    Andreadis N, Petty TL. Adult respiratory distress syndrome: problems and prognosis. Am Rev Respir Dis. 1985;132:1344–6.PubMedGoogle Scholar
  28. 28.
    Gaynes R, Bizek B, Mowry-Hanleyv J, Kirsh M. Risk factors of nosocomial pneumonia after coronary bypass graft operations. Ann Thorac Surg. 1991;5:215–18.CrossRefGoogle Scholar
  29. 29.
    Craven DE, Kunches LM, Kilinsky V, Lichtenbergv DA, Makev BJ, McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Ann Rev Respir Dis. 1986;133:792–6.Google Scholar
  30. 30.
    Stevens RM, Teres D, Skillman JJ. Pneumonia in an intensive care unit. A 30-month experience. Arch Intern Med. 1974;134:106–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Van Uffelen R, Rommes JH, Van Saene HKF. Prevenling lower airway colonization and infection in mechanically ventilated patients. Crit Care Med. 1987;15:99–102.PubMedCrossRefGoogle Scholar
  32. 32.
    Classener JAL, Vollaard FJ, van Saene HKF. Long-term prophylaxis of infection by selective decontamination in leukopenia and mechanical ventilation. Rev Infect Dis. 1987;9:225–328.Google Scholar
  33. 33.
    Gross JA, Neu HC, Oswapokee P, Van Antwerpen C, Aswapokee N.Deaths from nosocomial infections; experience in a university hospital and a community hospital. Am J Med. 1980;68:219–23.PubMedCrossRefGoogle Scholar
  34. 34.
    Miller PJ, Farr BM, Gwaltney JM. Economic benefits of an effective infection control program: case study and proposal. Rev Infect Dis. 1989;11:284–8.PubMedGoogle Scholar
  35. 35.
    Hill DJ. O’Brian TG, Murray JJ at al. Prolonged extracorporeal oxygenation for acute post-traumatic respiralory failure (shock-lung syndrome). N. Engl J Med. 1972;286:629–34.PubMedCrossRefGoogle Scholar
  36. 36.
    Gille JP, Bagniewski AM. Ten years of use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory insufficiency (ARD). Trans ASAIO. 1976;22:102–9.Google Scholar
  37. 37.
    Zapol WM, Snider MT, Hill JD et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. J Am Med Assoc. 1979;242:2193–6.CrossRefGoogle Scholar
  38. 38.
    NHLBI. Extracorporeal support for respiratory insufficiency: A collaborative study in response to RFP-NHLB1-73-20. NHLBI. December, NIH 1979.Google Scholar
  39. 39.
    Kolobow T. Extracorporeal respiratory gas exchange: a look into the future. ASAIO Trans. 1991;37:2–3.PubMedCrossRefGoogle Scholar
  40. 40.
    Gattinoni L, Pesenti A, Bambino Met al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology. 1988;69:824–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Marini JJ. Lung mechanics in the adult respiratory distress syndrome: recent conceptual advances and implications for management. Clin Chest Med. 1990; 11:673–90.PubMedGoogle Scholar
  42. 42.
    Kolobow T, Moretti MP, Fumagalli R et al. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation: an experimental study. Annu Rev Respir Dis. 1987;135:312–15.Google Scholar
  43. 43.
    Barsch J, Birbara C, Eggers GWN. Positive pressure as a cause of respiratory induced lung disease. Ann Intern Med. 1970;72:810 (abstract).Google Scholar
  44. 44.
    Gattinoni L. The use of extracorporeal support for adult respiratory distress syndrome. In: Yacoub M, editor. Annual of cardiac surgery. London: Current Science Ltd; 1989:56–61.Google Scholar
  45. 45.
    Morris AH, Wallace CJ, Clemmer TP et al. Extracorporeal CO2 removal therapy for adult respiratory distress syndrome patients: a computerized protocol controlled trial. Rean Soins Intens Mid Urg. 1990;6:485–90.Google Scholar
  46. 46.
    Toomasian JM, Snedecor SM, Cornell RG, Cilley RE, Bartlett RH. National experience with extracorporeal membrane oxygenation for newborn respiratory failure. ASAIO Trans. 1988;34:140–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Gattinoni L, Pesenti A, Mascheroni D. Low frequency positive pressure ventilation and extracorporeal CO2 removal in severe acute respiratory failure: clinical results. J Am Med Assoc. 1988;256:881–6.CrossRefGoogle Scholar
  48. 48.
    Gattinoni L, Pesenti A, Mascheroni Det al. Low frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. J Am Med Assoc. 1986;256:881–6.CrossRefGoogle Scholar
  49. 49.
    Anderson HL, Delius RE, Sinard JMet al. Early experience with adult extracorporeal membrane oxygenation in the modern era. Ann Thorac Surg. 1992;53:553–63.PubMedCrossRefGoogle Scholar
  50. 50.
    Grodins FS, Yamashiro SM. Respiratory function of the lung and its control. New York: Macmillan;978.Google Scholar
  51. 51.
    Friedman MH. Principles and models of biological transport. Berlin: Springer-Verlag; 1987:237.Google Scholar
  52. 52.
    Weibel ER, Federspiel WJ, Fryder-Doffey F,et al. Morphometric model for pulmonary diffusing capacity. I. Membrane diffusing capacity. Resp Physiol. 1993;93:124–49.Google Scholar
  53. 53.
    Mulder M. Basic principles of membrane technology. Dordrecht: Kluwer; 1991.Google Scholar
  54. 54.
    Federspiel WJ, Lund LW, Wallace MA, Williams JL, Wattler BG. Development of a novel intravenous membrane oxygenator. Annual Report for the Department of the Army. 1994–1995.Google Scholar
  55. 55.
    Yasuda H, Lamaze CE. Transfer of gas to dissolved oxygen in water via porous and nonporous polymer membranes. J Appl Polymer Sci. 1972;16:595–601.CrossRefGoogle Scholar
  56. 56.
    Qi Z, Cussler EL. Microporous hollow fibers for gas absorption. II. Mass transfer across the membrane. J Membrane Sci. 1985;23:333–45.CrossRefGoogle Scholar
  57. 57.
    Kamo J, Uchida M, Hirai T, asida H, Knada K, Takemura T: A new multilayered composite hollow fiber membrane for artificial lung. Artif Org. 1990;14:369–72.Google Scholar
  58. 58.
    Wickramasinghe SR, Semmens MJ, Cussler EL. Better hollow fiber contactors. J Membrane Sci. 1991;62:371–88.CrossRefGoogle Scholar
  59. 59.
    Sinard JM, Bartlett RH. Extracorporeal life support in critical care medicine. J Crit Care Med. 1990;5:265–78.CrossRefGoogle Scholar
  60. 60.
    Truog RD. Randomized controlled trials: lessons from ECMO. Clin Res. 1992;40:519–27.PubMedGoogle Scholar
  61. 61.
    Anderson H, Stremple C, Shapiro Met al. Extracorporeal life support for adult cardiorespiratory failure. Surgery. 1993;114:161–73.PubMedGoogle Scholar
  62. 62.
    Bodell BR, Head JM, Head LR, Formolo AJ. An implantable artificial lung. J Am Med Assoc. 1965;191:125–7.CrossRefGoogle Scholar
  63. 63.
    Conrad SA, Bagley A, Bagley B, Schaap RNet al. Major findings from the clinical trials of the intravascular oxygenator. Artif Org. 1994;18:846–63.Google Scholar
  64. 64.
    Awad JA, Caron WM, Brassard A, Cadrin C.Pulmonary support by intravenous oxygenation through capillary silicone rubber tubing. Am J Surg. 1971;121:307–10.PubMedCrossRefGoogle Scholar
  65. 65.
    Galetti PM, Richardson PD, Trudell LA, Panol G, Tanishita K, Accinelli D. Development of an implantable booster lung. Trans ASAIO. 1980;26:573–7.Google Scholar
  66. 66.
    Tanishita K, Nakano K, Sakurai Y, Hosokawa T, Richardson PD, Galetti PM Compact oxygenator design with curved tubes wound in weaving patterns. Trans ASAIO. 1978;24:327–31.Google Scholar
  67. 67.
    Palmer AS, Collins J, Head LR.Development of an implantable artificial lung. J Thorac Card Surg. 1973;66:521–5.Google Scholar
  68. 68.
    Fazzalari FL, Montoya JP, Bonnell MR, Bliss DW, Hirschl RB, Barlett RH. The development of an implantable artificial lung. ASAIO J. 1994;40:M728–31.PubMedGoogle Scholar
  69. 69.
    Vaslef SN, Cook KE, Leonard RJ, Mockros LF, Anderson RW. Design and evaluation of a new low pressure loss, implantable artificial lung. ASAIO J. 1994;40:M522–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Luzsa G. X-Ray anatomy of the vascular system. Philadelphia, PA: J.P. Lippincott; 1974:243–7.Google Scholar
  71. 71.
    Mortensen JD, Berry G. Conceptual and design features of a practical, clinically effective intravenous mechanical blood oxygen/carbon dioxide exchange device (IVOX). Int J Artif Organ. 1989;12:384–9.Google Scholar
  72. 72.
    Mortensen JD. An intravenacaval blood gas exchange (IVCBGE) device, a preliminary report. Trans ASAIO. 1987;33:570–3.Google Scholar
  73. 73.
    Mortensen JD. Intravascular oxygenator: a new alternative method for augmenting blood gas transfer in patients with acute respiratory failure. Artif Org. 1992;16:75–82.CrossRefGoogle Scholar
  74. 74.
    Tonz M, von Segesser LK, Leskosek B, Turina MI. Quantitative gas transfer of an intravascular oxygenator. Ann Thorac Surg. 1994;57:146–50.PubMedCrossRefGoogle Scholar
  75. 75.
    Hauler BG, Johnson PC, Sawzik PJ et al. Respiratory dialysis: a new concept in pul-monary support. ASAIO J. 1992;38:M322–5.CrossRefGoogle Scholar
  76. 76.
    Reeder GD, Hattler BG, Rawleigh JD et al. Current progress in the development of an intravenous membrane oxygenator. ASAIO J. 1993;39:M461–5.PubMedCrossRefGoogle Scholar
  77. 77.
    Hattler BG, Reeder GD, Sawzik PJ et al. Development of an intravenous membrane oxygenator: enhanced intravenous gas exchange through convective mixing of blood around hollow fiber membranes. Artif Org. 1994;18:806–12.Google Scholar
  78. 78.
    Vaslef SN, Mockros LF, Anderson RW. Development of an intravascular lung assist device. Trans ASAIO. 1989;35:660–4.CrossRefGoogle Scholar
  79. 79.
    Makarewicz AJ, Mockros LF, Anderson RW. A pumping intravascular artificial lung with active mixing. ASAIO J. 1993;39:M466–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Makarewicz J, Mockros LF, Anderson RW. A dynamic intravascular artificial lung. ASAIO J. 1994;40:M747–50.PubMedGoogle Scholar
  81. 81.
    Snider MT, High KM, Richard RBet al. Small intrapulmonary artery lung prototypes: design, construction, and in vitro water testing. ASAIO J. 1994;40:M533–9.PubMedGoogle Scholar
  82. 82.
    High KM, Nicholson T, Richard RB, Panol G, Shelley K, Snider MT. Effects of blood phase oscillation on gas transfer in a microporous intravascular lung. ASAIO J. 1994;40:M735–9.PubMedCrossRefGoogle Scholar
  83. 83.
    Snider M, Panol G, High K, et al. J. Moderate sized intrapulmonary artery lines-construction, in vivo implantation and in vitro blood-to-gas transfer. ASAIO Abstracts 41st Annual Meeting.Chicago, IL; 1995.Google Scholar
  84. 84.
    Thomsen G, Morris A, Danino D, Ellsworth J, Wallace C. Incidence of the adult respiratory diotress syndrome in Utah. Am Rev Respir Dis. 1993; 147:A347.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • W. Federspiel
  • P. Sawzik
  • H. Borovetz
  • G. D. Reeder
  • B. G. Hattler

There are no affiliations available

Personalised recommendations