Rescue therapy for hypercapnia due to high PEEP mechanical ventilation in patients with ARDS and renal failure

Grant, April A.; Hart, Valerie; Lineen, Edward B.; Forsberg, Brian C.; Klima, Alan; Mirsaeidi, Mehdi; Schulman, Ivonne Hernandez; Badiye, Amit; Vianna, Rodrigo; Patel, Amit N.; Loebe, Matthias; Ghodsizad, Ali

doi:10.1111/aor.13393

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…As of 2018, there have been two randomized control trials evaluating extracorporeal CO 2 removal in ARDS [116], with one study [117] finding no significant difference in mortality but a dramatic increase in the complexity of care and as such was not a recommended treatment. The second study was performed by Bein et al [114] who showed that ECCO 2 R did not confer any improved survival but allowed for lower tidal volumes reducing the risk of VILI.…”

Section: Extracorporeal Co 2 Removalmentioning

confidence: 99%

Hypercapnia in the critically ill: insights from the bench to the bedside

et al. 2021

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Carbon dioxide (CO 2 ) has long been considered, at best, a waste by-product of metabolism, and at worst, a toxic molecule with serious health consequences if physiological concentration is dysregulated. However, clinical observations have revealed that ‘permissive’ hypercapnia, the deliberate allowance of respiratory produced CO 2 to remain in the patient, can have anti-inflammatory effects that may be beneficial in certain circumstances. In parallel, studies at the cell level have demonstrated the profound effect of CO 2 on multiple diverse signalling pathways, be it the effect from CO 2 itself specifically or from the associated acidosis it generates. At the whole organism level, it now appears likely that there are many biological sensing systems designed to respond to CO 2 concentration and tailor respiratory and other responses to atmospheric or local levels. Animal models have been widely employed to study the changes in CO 2 levels in various disease states and also to what extent permissive or even directly delivered CO 2 can affect patient outcome. These findings have been advanced to the bedside at the same time that further clinical observations have been elucidated at the cell and animal level. Here we present a synopsis of the current understanding of how CO 2 affects mammalian biological systems, with a particular emphasis on inflammatory pathways and diseases such as lung specific or systemic sepsis. We also explore some future directions and possibilities, such as direct control of blood CO 2 levels, that could lead to improved clinical care in the future.

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Section: Extracorporeal Co 2 Removalmentioning

confidence: 99%

Hypercapnia in the critically ill: insights from the bench to the bedside

et al. 2021

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“…42 CVVRRT systems equipped with a small gas exchange membrane provide an opportunity to remove CO 2 with less invasive devices that are more readily available at even smaller hospitals, thus allowing for safer ventilatory strategies. 39 ECMO technology-based ECCO 2 R systems. ECMO-based systems share centrifugal magnetically driven pumps.…”

Section: Vv Ecco 2 Rmentioning

confidence: 99%

“…Usually high-flow standard dialysis catheters are sufficient to achieve blood flows above 300-400 mL/min. 39 At blood flows as low as these, no oxygenation effect can be expected as well as CO 2 removal itself is limited: the Prismalung © system has been shown to reduce PaCO 2 by 21%, 40 the Decap Smart © system, which uses a distinct technology of removing CO 2 from re-circulating plasma water, was able to achieve a decrease in PaCO 2 by 17-22% in an experimental animal setting 41 and by about 32% in ARDS patients. 42 CVVRRT systems equipped with a small gas exchange membrane provide an opportunity to remove CO 2 with less invasive devices that are more readily available at even smaller hospitals, thus allowing for safer ventilatory strategies.…”

Section: The Circuitmentioning

confidence: 99%

Update on extracorporeal carbon dioxide removal: a comprehensive review on principles, indications, efficiency, and complications

Staudinger

2020

Perfusion

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Technology: Extracorporeal carbon dioxide removal means the removal of carbon dioxide from the blood across a gas exchange membrane without substantially improving oxygenation. Carbon dioxide removal is possible with substantially less extracorporeal blood flow than needed for oxygenation. Techniques for extracorporeal carbon dioxide removal include (1) pumpless arterio-venous circuits, (2) low-flow venovenous circuits based on the technology of continuous renal replacement therapy, and (3) venovenous circuits based on extracorporeal membrane oxygenation technology. Indications: Extracorporeal carbon dioxide removal has been shown to enable more protective ventilation in acute respiratory distress syndrome patients, even beyond the so-called “protective” level. Although experimental data suggest a benefit on ventilator induced lung injury, no hard clinical evidence with respect to improved outcome exists. In addition, extracorporeal carbon dioxide removal is a tool to avoid intubation and mechanical ventilation in patients with acute exacerbated chronic obstructive pulmonary disease failing non-invasive ventilation. This concept has been shown to be effective in 56-90% of patients. Extracorporeal carbon dioxide removal has also been used in ventilated patients with hypercapnic respiratory failure to correct acidosis, unload respiratory muscle burden, and facilitate weaning. In patients suffering from terminal fibrosis awaiting lung transplantation, extracorporeal carbon dioxide removal is able to correct acidosis and enable spontaneous breathing during bridging. Keeping these patients awake, ambulatory, and breathing spontaneously is associated with favorable outcome. Complications: Complications of extracorporeal carbon dioxide removal are mostly associated with vascular access and deranged hemostasis leading to bleeding. Although the spectrum of complications may differ, no technology offers advantages with respect to rate and severity of complications. So called “high-extraction systems” working with higher blood flows and larger membranes may be more effective with respect to clinical goals.

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“…April A. Grant et al of the University of Miami, Miami, FL, USA described the use of partial lung support by extracorporeal removal of carbon dioxide in patients in patients with acute respiratory distress syndrome complicated by severe hypercapnia due to high PEEP mechanical ventilation and acute kidney injury requiring dialysis.…”

Section: Pulmonary Supportmentioning

confidence: 99%

Artificial Organs 2019: A year in review

Malchesky¹

2020

Artificial Organs

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In this Editor’s Review, articles published in 2019 are organized by category and summarized. These provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer‐reviewed Special Issues this year included contributions from the 14th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr Akif Undar, and the 26th Congress of the International Society for Mechanical Circulatory Support edited by Dr Minoru Ono and Dr Francesco Moscato. Additionally, important editorials highlighted the need for sustainability in hemodialysis, challenges and opportunities in mechanical circulatory support, progress in artificial pancreas development, historical perspectives on ventilators and dialysis, tissue engineering for cardiac support, and regional updates from India and China. Our Pioneer Series continues to highlight the many researchers who created this field of study. This year we debuted a new series entitled “Recent Progress in Artificial Organs” prepared by Vakhtang Tchantchaleishvili and Elizabeth Maynes of Thomas Jefferson University, Philadelphia, PA, USA. This series highlights recent advances and new developments in the field. We take this time also to express our gratitude to our authors for contributing their work to this journal. We offer our very special thanks to our reviewers who give so generously of their time and expertise to review, critique, and especially provide meaningful suggestions to the author’s work. Without our dedicated expert reviewers, the quality expected from such a journal would not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production Artificial Organs. We look forward to reporting further advances in the coming years.

show abstract

Rescue therapy for hypercapnia due to high PEEP mechanical ventilation in patients with ARDS and renal failure

Cited by 9 publications

References 9 publications

Hypercapnia in the critically ill: insights from the bench to the bedside

Hypercapnia in the critically ill: insights from the bench to the bedside

Update on extracorporeal carbon dioxide removal: a comprehensive review on principles, indications, efficiency, and complications

Artificial Organs 2019: A year in review

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