Mobilizing Carbon Dioxide Stores. An Experimental Study

Giosa, Lorenzo; Busana, Mattia; Bonifazi, Matteo; Romitti, Federica; Vassalli, Francesco; Pasticci, Iacopo; Macrí, Matteo Maria; D’Albo, Rosanna; Collino, Francesca; Gatta, Alessandro; Palumbo, Maria Michela; Herrmann, Peter; Moerer, Onnen; Iapichino, G.; Meissner, Konrad; Quintel, Michael; Gattinoni, Luciano

doi:10.1164/rccm.202005-1687oc

Cited by 20 publications

(17 citation statements)

References 19 publications

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“…In vivo experiments by Gattinoni et al have provided a physiological rationale for extracorporeal CO 2 removal, demonstrating that it is an effective way to mobilize CO 2 stores in the body and that the relative change of PaCO 2 is related to the amount of CO 2 stores mobilized. 26 These findings are consistent with previous in vitro data with the ADVOS system removing up to 25% of the body's normal CO 2 (assuming the amount of CO 2 produced by a healthy adult human is 210 mL/min). 20,27 Beside these in vitro experiments it is well known that severe hypercapnia affects the function of extrapulmonary organs including the brain and the cardiovascular system in a negative manner.…”

Section: Discussionsupporting

confidence: 92%

“…Extracorporeal CO 2 removal has gained attention in recent years for several reasons. In vivo experiments by Gattinoni et al have provided a physiological rationale for extracorporeal CO 2 removal, demonstrating that it is an effective way to mobilize CO 2 stores in the body and that the relative change of PaCO 2 is related to the amount of CO 2 stores mobilized 26 . These findings are consistent with previous in vitro data with the ADVOS system removing up to 25% of the body's normal CO 2 (assuming the amount of CO 2 produced by a healthy adult human is 210 mL/min) 20,27 …”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal carbon dioxide removal with the Advanced Organ Support system in critically ill COVID‐19 patients

et al. 2021

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Disturbed oxygenation is foremost the leading clinical presentation in COVID-19 patients. However, a small proportion also develop carbon dioxide removal problems. The Advanced Organ Support (ADVOS) therapy (ADVITOS GmbH, Munich, Germany) uses a less invasive approach by combining extracorporeal CO 2 -removal and multiple organ support for the liver and the kidneys in a single hemodialysis device. The aim of our study is to evaluate the ADVOS system

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Extracorporeal carbon dioxide removal with the Advanced Organ Support system in critically ill COVID‐19 patients

et al. 2021

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“…Indeed, the low VCO 2 measured in quartile 1 possibly represents only a fraction of the metabolic CO 2 production which is partly retained. Increased alveolar ventilation throughout the quartiles leads to a normalization or even a higher than normal (metabolic) CO 2 clearance [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

End-tidal to arterial PCO2 ratio: a bedside meter of the overall gas exchanger performance

Bonifazi

Romitti

Busana

et al. 2021

ICMx

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Background The physiological dead space is a strong indicator of severity and outcome of acute respiratory distress syndrome (ARDS). The “ideal” alveolar PCO2, in equilibrium with pulmonary capillary PCO2, is a central concept in the physiological dead space measurement. As it cannot be measured, it is surrogated by arterial PCO2 which, unfortunately, may be far higher than ideal alveolar PCO2, when the right-to-left venous admixture is present. The “ideal” alveolar PCO2 equals the end-tidal PCO2 (PETCO2) only in absence of alveolar dead space. Therefore, in the perfect gas exchanger (alveolar dead space = 0, venous admixture = 0), the PETCO2/PaCO2 is 1, as PETCO2, PACO2 and PaCO2 are equal. Our aim is to investigate if and at which extent the PETCO2/PaCO2, a comprehensive meter of the “gas exchanger” performance, is related to the anatomo physiological characteristics in ARDS. Results We retrospectively studied 200 patients with ARDS. The source was a database in which we collected since 2003 all the patients enrolled in different CT scan studies. The PETCO2/PaCO2, measured at 5 cmH2O airway pressure, significantly decreased from mild to mild–moderate moderate–severe and severe ARDS. The overall populations was divided into four groups (~ 50 patients each) according to the quartiles of the PETCO2/PaCO2 (lowest ratio, the worst = group 1, highest ratio, the best = group 4). The progressive increase PETCO2/PaCO2 from quartile 1 to 4 (i.e., the progressive approach to the “perfect” gas exchanger value of 1.0) was associated with a significant decrease of non-aerated tissue, inohomogeneity index and increase of well-aerated tissue. The respiratory system elastance significantly improved from quartile 1 to 4, as well as the PaO2/FiO2 and PaCO2. The improvement of PETCO2/PaCO2 was also associated with a significant decrease of physiological dead space and venous admixture. When PEEP was increased from 5 to 15 cmH2O, the greatest improvement of non-aerated tissue, PaO2 and venous admixture were observed in quartile 1 of PETCO2/PaCO2 and the worst deterioration of dead space in quartile 4. Conclusion The ratio PETCO2/PaCO2 is highly correlated with CT scan, physiological and clinical variables. It appears as an excellent measure of the overall “gas exchanger” status.

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“…First, due to the ethical concerns raised by our IRBAC, few animals have been included; thus, our data cannot be directly transferred to humans with acute respiratory distress syndrome (ARDS) or decompensated COPD. Further, the blood and the interstitial fluid account only for less than 20% of the total human CO 2 stores that can be mobilized within 48 h [18]. Thus, adding CO 2 with an external source for a limited amount of time is not the most accurate strategy to increase CO 2 storages [18].…”

Section: Discussionmentioning

confidence: 99%

“…Further, the blood and the interstitial fluid account only for less than 20% of the total human CO 2 stores that can be mobilized within 48 h [18]. Thus, adding CO 2 with an external source for a limited amount of time is not the most accurate strategy to increase CO 2 storages [18]. However, we adopted this approach, previously used by other authors [15,16] to rapidly increase P pre CO 2 , avoiding the reduction of tidal volume (<4 mL/kg) and respiratory rate to unsafe levels that could have required an adjustment of the ventilator settings.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a New Extracorporeal CO2 Removal Device in an Experimental Setting

Nardo

Annoni

et al. 2020

Membranes

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Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO2 removal (ECCO2R). We tested the CO2 removal performance of a new ECCO2R (CO2RESET) device in an experimental animal model. Methods: Three healthy pigs were mechanically ventilated and connected to the CO2RESET device (surface area = 1.8 m2, EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO2 (target pre membrane lung venous PCO2 (PpreCO2): 80–120 mmHg). The amount of CO2 removed (VCO2, mL/min) by the membrane lung was assessed directly by the ECCO2R device. Results: Before the initiation of ECCO2R, the median PpreCO2 was 102.50 (95.30–118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO2 progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00–200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO2 was observed increasing the gas flow from 0 to 2 L/min, then, VCO2 tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed. Conclusions: Medium-flow ECCO2R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m2) provided a high VCO2 using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs.

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Mobilizing Carbon Dioxide Stores. An Experimental Study

Cited by 20 publications

References 19 publications

Extracorporeal carbon dioxide removal with the Advanced Organ Support system in critically ill COVID‐19 patients

Extracorporeal carbon dioxide removal with the Advanced Organ Support system in critically ill COVID‐19 patients

End-tidal to arterial PCO2 ratio: a bedside meter of the overall gas exchanger performance

Evaluation of a New Extracorporeal CO2 Removal Device in an Experimental Setting

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