51. Extracorporeal carbon dioxide removal through ventilation of acidified dialysate: An experimental study
- Author
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Simone Sosio, Luigi Castagna, Sara Redaelli, Marco Giani, Vittorio Scaravilli, Nicolò Patroniti, Paolo Mangili, Mariangela Albertini, Alberto Zanella, Federica Pirrone, Antonio Pesenti, Zanella, A, Mangili, P, Giani, M, Redaelli, S, Scaravilli, V, Castagna, L, Sosio, S, Pirrone, F, Albertini, M, Patroniti, N, and Pesenti, A
- Subjects
Pulmonary and Respiratory Medicine ,Swine ,medicine.medical_treatment ,law.invention ,chemistry.chemical_compound ,carbon dioxide ,Extracorporeal circulation ,extracorporeal membrane oxygenation ,ventilator-induced lung injury ,Surgery ,Cardiology and Cardiovascular Medicine ,Transplantation ,Renal Dialysis ,law ,Dialysis Solutions ,Extracorporeal membrane oxygenation ,Animals ,Medicine ,Dialysis ,Mechanical ventilation ,Chromatography ,business.industry ,Blood flow ,Hydrogen-Ion Concentration ,Respiration, Artificial ,Lactic acid ,Disease Models, Animal ,chemistry ,Anesthesia ,Carbon dioxide ,Ventilation (architecture) ,business - Abstract
Background Extracorporeal (EC) carbon dioxide (CO 2 ) removal (ECCO 2 R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO 2 R. We evaluated an innovative ECCO 2 R technique based on ventilation of acidified dialysate. Methods Four swine were sedated, mechanically ventilated, and connected to a venovenous dialysis circuit (blood flow, 250 ml/min). The dialysate was recirculated in a closed loop circuit including a ML (gas flow, 10 liters/min) and then returned to the dialyzer. In each animal, 4 different dialysis flows (DF) of 200, 400, 600, and 800 ml/min were evaluated with and without lactic acid infusion (2.5 mEq/min); the sequence was completed 3 times. At the end of each step, we measured the volume of CO 2 R by the ML (Vco 2 ML) and collected blood and dialysate samples for gas analyses. Results Acid infusion substantially increased Vco 2 ML, from 33 ± 6 ml/min to 86 ± 7 ml/min. Different DFs had little effect on Vco 2 ML, which was only slightly reduced at DF 200 ml/min. The partial pressure of CO 2 of blood passing through the dialysis filter changed from 60.9 ± 3.6 to 37.1 ± 4.8 mm Hg without acidification and to 32.5 ± 5.3 mm Hg with acidification, corresponding to a pH increase of 0.18 ± 0.03 and 0.03 ± 0.04 units, respectively. Conclusions Ventilation of acidified dialysate efficiently increased ECCO 2 R of an amount corresponding to 35% to 45% of the total CO 2 production of an adult man from a blood flow as low as 250 ml/min.
- Published
- 2014