Cargando…
Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis
BACKGROUND: Veno-venous extracorporeal CO(2) removal (vv-ECCO(2)R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m(2). The present study...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539069/ https://www.ncbi.nlm.nih.gov/pubmed/28766276 http://dx.doi.org/10.1186/s40635-017-0147-0 |
_version_ | 1783254409649586176 |
---|---|
author | Karagiannidis, Christian Strassmann, Stephan Brodie, Daniel Ritter, Philine Larsson, Anders Borchardt, Ralf Windisch, Wolfram |
author_facet | Karagiannidis, Christian Strassmann, Stephan Brodie, Daniel Ritter, Philine Larsson, Anders Borchardt, Ralf Windisch, Wolfram |
author_sort | Karagiannidis, Christian |
collection | PubMed |
description | BACKGROUND: Veno-venous extracorporeal CO(2) removal (vv-ECCO(2)R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m(2). The present study in an animal model with similar CO(2) production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO(2)R. METHODS: Four different membrane lungs, with varying lung surface areas of 0.4, 0.8, 1.0, and 1.3m(2) were used to perform vv-ECCO(2)R in seven anesthetized, mechanically ventilated, pigs with experimentally induced severe respiratory acidosis (pH 7.0–7.1) using a 20Fr double-lumen catheter with a sweep gas flow rate of 8 L/min. During each experiment, the blood flow was increased stepwise from 250 to 1000 ml/min. RESULTS: Amelioration of severe respiratory acidosis was only feasible when blood flow rates from 750 to 1000 ml/min were used with a membrane lung surface area of at least 0.8 m(2). Maximal CO(2) elimination was 150.8 ml/min, with pH increasing from 7.01 to 7.30 (blood flow 1000 ml/min; membrane lung 1.3 m(2)). The membrane lung with a surface of 0.4 m(2) allowed a maximum CO(2) elimination rate of 71.7 mL/min, which did not result in the normalization of pH, even with a blood flow rate of 1000 ml/min. Also of note, an increase of the surface area above 1.0 m(2) did not result in substantially higher CO(2) elimination rates. The pressure drop across the oxygenator was considerably lower (<10 mmHg) in the largest membrane lung, whereas the smallest revealed a pressure drop of more than 50 mmHg with 1000 ml blood flow/min. CONCLUSIONS: In this porcine model, vv-ECCO(2)R was most effective when using blood flow rates ranging between 750 and 1000 ml/min, with a membrane lung surface of at least 0.8 m(2). In contrast, low blood flow rates (250–500 ml/min) were not sufficient to completely correct severe respiratory acidosis, irrespective of the surface area of the membrane lung being used. The converse was also true, low surface membrane lungs (0.4 m(2)) were not capable of completely correcting severe respiratory acidosis across the range of blood flows used in this study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40635-017-0147-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5539069 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-55390692017-08-17 Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis Karagiannidis, Christian Strassmann, Stephan Brodie, Daniel Ritter, Philine Larsson, Anders Borchardt, Ralf Windisch, Wolfram Intensive Care Med Exp Research BACKGROUND: Veno-venous extracorporeal CO(2) removal (vv-ECCO(2)R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m(2). The present study in an animal model with similar CO(2) production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO(2)R. METHODS: Four different membrane lungs, with varying lung surface areas of 0.4, 0.8, 1.0, and 1.3m(2) were used to perform vv-ECCO(2)R in seven anesthetized, mechanically ventilated, pigs with experimentally induced severe respiratory acidosis (pH 7.0–7.1) using a 20Fr double-lumen catheter with a sweep gas flow rate of 8 L/min. During each experiment, the blood flow was increased stepwise from 250 to 1000 ml/min. RESULTS: Amelioration of severe respiratory acidosis was only feasible when blood flow rates from 750 to 1000 ml/min were used with a membrane lung surface area of at least 0.8 m(2). Maximal CO(2) elimination was 150.8 ml/min, with pH increasing from 7.01 to 7.30 (blood flow 1000 ml/min; membrane lung 1.3 m(2)). The membrane lung with a surface of 0.4 m(2) allowed a maximum CO(2) elimination rate of 71.7 mL/min, which did not result in the normalization of pH, even with a blood flow rate of 1000 ml/min. Also of note, an increase of the surface area above 1.0 m(2) did not result in substantially higher CO(2) elimination rates. The pressure drop across the oxygenator was considerably lower (<10 mmHg) in the largest membrane lung, whereas the smallest revealed a pressure drop of more than 50 mmHg with 1000 ml blood flow/min. CONCLUSIONS: In this porcine model, vv-ECCO(2)R was most effective when using blood flow rates ranging between 750 and 1000 ml/min, with a membrane lung surface of at least 0.8 m(2). In contrast, low blood flow rates (250–500 ml/min) were not sufficient to completely correct severe respiratory acidosis, irrespective of the surface area of the membrane lung being used. The converse was also true, low surface membrane lungs (0.4 m(2)) were not capable of completely correcting severe respiratory acidosis across the range of blood flows used in this study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40635-017-0147-0) contains supplementary material, which is available to authorized users. Springer International Publishing 2017-08-01 /pmc/articles/PMC5539069/ /pubmed/28766276 http://dx.doi.org/10.1186/s40635-017-0147-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Karagiannidis, Christian Strassmann, Stephan Brodie, Daniel Ritter, Philine Larsson, Anders Borchardt, Ralf Windisch, Wolfram Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title | Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title_full | Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title_fullStr | Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title_full_unstemmed | Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title_short | Impact of membrane lung surface area and blood flow on extracorporeal CO(2) removal during severe respiratory acidosis |
title_sort | impact of membrane lung surface area and blood flow on extracorporeal co(2) removal during severe respiratory acidosis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539069/ https://www.ncbi.nlm.nih.gov/pubmed/28766276 http://dx.doi.org/10.1186/s40635-017-0147-0 |
work_keys_str_mv | AT karagiannidischristian impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT strassmannstephan impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT brodiedaniel impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT ritterphiline impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT larssonanders impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT borchardtralf impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis AT windischwolfram impactofmembranelungsurfaceareaandbloodflowonextracorporealco2removalduringsevererespiratoryacidosis |