Carbon dioxide dialysis will save the lung

Pesenti, Antonio; Patroniti, Nicolò

doi:10.1097/ccm.0b013e3181f1fe0c

Cited by 36 publications

(31 citation statements)

References 41 publications

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“…There is some evidence suggesting that ECCO 2 R may facilitate lower volumes, lower plateau pressures, and lower driving pressures by controlling hypercapnoea. [7][8][9] The other patient cohort where ECCO 2 R is promising is in patients with a severe exacerbation of chronic obstructive pulmonary disease (COPD) leading to hypercapnic respiratory failure. In these patients, the current gold standard therapy is noninvasive ventilation (NIV).…”

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confidence: 99%

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

et al. 2016

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We aimed to describe the use of venovenous extracorporeal carbon dioxide removal (ECCO2R) in patients with hypercapnic respiratory failure. We performed a retrospective case note review of patients admitted to our tertiary regional intensive care unit and commenced on ECCO2R from August 2013 to February 2015. Fourteen patients received ECCO2R. Demographic data, physiologic data (including pH and partial pressure of carbon dioxide in arterial blood [PaCO2]) when starting ECCO2R (t = 0), at 4 hourly intervals for the first 24 hours, then at 24 hour intervals until cessation of ECCO2R, and overall outcome were recorded. Patients are reported separately depending on whether the indication for ECCO2R was an exacerbation of chronic obstructive pulmonary disease (COPD; n = 5), or acute respiratory distress syndrome (ARDS) and persisting hypercapnoea (n = 9). Patients were managed with ECCO2R (Hemolung, ALung Inc, Pittsburgh, PA). Median duration of ECCO2R was 5 days. Four complications related to ECCO2R were reported, none resulting in serious adverse outcomes. Ten patients were discharged from intensive care unit (ICU) alive. A statistically significant improvement in pH (p = 0.012) was demonstrated. Our observational series of ECCO2R shows that this technique can be safely used to achieve therapeutic goals in patients requiring lung protection, and in COPD, in line with current publications in this area.

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confidence: 99%

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

et al. 2016

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“…Delivery of low tidal volumes and airway pressures mitigates these deleterious effects, as demonstrated by the acute respiratory distress syndrome (ARDS) Network trial where low tidal volume MV at 6 mL/kg vs 12 mL/kg reduced lung injury and improved survival [4]. Recent data suggests even more ultra-protective MV settings may further improve outcomes, as alveolar over-distention is still observed at 6 mL/kg [3], [5], [6]. Clinicians are often unable to apply lung protective ventilation (LPV) strategies, reporting hypercapnia and acidosis as significant barriers to implementation [7].…”

Section: Introductionmentioning

confidence: 99%

Acidic sweep gas with carbonic anhydrase coated hollow fiber membranes synergistically accelerates CO2 removal from blood

et al. 2015

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The use of extracorporeal carbon dioxide removal (ECCO2R) is well established as a therapy for patients suffering from acute respiratory failure. Development of next generation low blood flow (< 500 mL/min) ECCO2R devices necessitates more efficient gas exchange devices. Since over 90% of blood CO2 is transported as bicarbonate (HCO3−), we previously reported development of a carbonic anhydrase (CA) immobilized bioactive hollow fiber membrane (HFM) which significantly accelerates CO2 removal from blood in model gas exchange devices by converting bicarbonate to CO2 directly at the HFM surface. This present study tested the hypothesis that dilute sulfur dioxide (SO2) in oxygen sweep gas could further increase CO2 removal by creating an acidic microenvironment within the diffusional boundary layer adjacent to the HFM surface, facilitating dehydration of bicarbonate to CO2. CA was covalently immobilized onto poly (methyl pentene) (PMP) HFMs through glutaraldehyde activated chitosan spacers, potted in model gas exchange devices (0.0151m2) and tested for CO2 removal rate with oxygen (O2) sweep gas and a 2.2% SO2 in oxygen sweep gas mixture. Using pure O2 sweep gas, CA-PMP increased CO2 removal by 31% (258 mL/min/m2) compared to PMP (197 mL/min/m2) (P < 0.05). Using 2.2% SO2 acidic sweep gas increased PMP CO2 removal by 17% (230 mL/min/m2) compared to pure oxygen sweep gas control (P < 0.05); device outlet blood pH was 7.38 units. When employing both CA-PMP and 2.2% SO2 sweep gas, CO2 removal increased by 109% (411 mL/min/m2) (P < 0.05); device outlet blood pH was 7.35 units. Dilute acidic sweep gas increases CO2 removal, and when used in combination with bioactive CA-HFMs has a synergistic effect to more than double CO2 removal while maintaining physiologic pH. Through these technologies the next generation of intravascular and paracorporeal respiratory assist devices can remove more CO2 with smaller blood contacting surface areas.

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“…With current technology this approach may be limited by a relatively low amount of CO 2 removal (12)(13)(14)(15). We aimed at significantly increasing the amount of CO 2 removed from a given blood flow, so as to achieve a greater decrease of ventilation and expand the spectrum of potential clinical applications (16)(17)(18).…”

Section: At a Glance Commentarymentioning

confidence: 99%

Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO₂ Removal Technique

Zanella

Castagna

Salerno

et al. 2015

Am J Respir Crit Care Med

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Rationale: We developed an innovative, minimally invasive, highly efficient extracorporeal CO 2 removal (ECCO 2 R) technique called respiratory electrodialysis (R-ED).Objectives: To evaluate the efficacy of R-ED in controlling ventilation compared with conventional ECCO 2 R technology.Methods: Five mechanically ventilated swine were connected to a custom-made circuit optimized for R-ED, consisting of a hemofilter, a membrane lung, and an electrodialysis cell. Electrodialysis regionally modulates blood electrolyte concentration to convert bicarbonate to CO 2 before entering the membrane lung, enhancing membrane lung CO 2 extraction. All animals underwent three repeated experimental sequences, consisting of four steps: baseline (1 h), conventional ECCO 2 R (2 h), R-ED (2 h), and final NO-ECCO 2 R (1 h). Blood and gas flow were 250 ml/min and 10 L/min, respectively. Tidal volume was set at 8 ml/kg, and respiratory rate was adjusted to maintain arterial PCO 2 at 50 mm Hg.Measurements and Main Results: During R-ED, chloride and H 1 concentration increased in blood entering the membrane lung, almost doubling CO 2 extraction compared with ECCO 2 R (112 6 6 vs. 64 6 5 ml/min, P , 0.001). Compared with baseline, R-ED and ECCO 2 R reduced minute ventilation by 50% and 27%, respectively. Systemic arterial gas analyses remained stable during the experimental phases. No major complication occurred, but there was an increase in creatinine level.Conclusions: In this first in vivo application, we proved electrodialysis feasible and effective in increasing membrane lung CO 2 extraction. R-ED was more effective than conventional ECCO 2 R technology in controlling ventilation. Further studies are warranted to assess the safety profile of R-ED, especially regarding kidney function.Keywords: extracorporeal circulation; carbon dioxide; respiratory insufficiency; hypercapnia At a Glance CommentaryScientific Knowledge on the Subject: Extracorporeal CO 2 removal (ECCO 2 R) has been suggested for the treatment of patients with acute and chronic respiratory failure. The current ECCO 2 R technology, although perfected compared to the past, still has room for improvement.What This Study Adds to the Field: We developed respiratory electrodialysis, an innovative extracorporeal CO 2 removal technique that selectively modulates pH and electrolyte concentration and highly enhances CO 2 removal by applying an electrical field to blood. Respiratory electrodialysis, requiring a minimally invasive approach, could greatly affect the way we treat patients suffering from respiratory failure and other conditions.

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Carbon dioxide dialysis will save the lung

Cited by 36 publications

References 41 publications

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

Acidic sweep gas with carbonic anhydrase coated hollow fiber membranes synergistically accelerates CO2 removal from blood

Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO₂ Removal Technique

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Carbon dioxide dialysis will save the lung

Cited by 36 publications

References 41 publications

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

Acidic sweep gas with carbonic anhydrase coated hollow fiber membranes synergistically accelerates CO2 removal from blood

Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO2 Removal Technique

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Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO₂ Removal Technique