scholarly journals Extracorporeal carbon dioxide removal requirements for ultraprotective mechanical ventilation: Mathematical model predictions

2019 ◽  
Vol 44 (5) ◽  
pp. 488-496
Author(s):  
John Kenneth Leypoldt ◽  
Jacques Goldstein ◽  
Dominique Pouchoulin ◽  
Kai Harenski
Keyword(s):  
Carbon Dioxide ◽  
Mathematical Model ◽  
Mechanical Ventilation ◽  
Carbon Dioxide Removal ◽  
Extracorporeal Carbon Dioxide Removal ◽  
Model Predictions

Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome

2015 ◽  
Vol 122 (3) ◽  
pp. 631-646 ◽  
Author(s):  
Andreas Güldner ◽  
Thomas Kiss ◽  
Thomas Bluth ◽  
Christopher Uhlig ◽  
Anja Braune ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Spontaneous Breathing ◽  
Distress Syndrome ◽  
Carbon Dioxide Removal ◽  
Intrapulmonary Shunt ◽  
Extracorporeal Carbon Dioxide Removal

Abstract Background: To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. Methods: Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. Results: The authors found that: (1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. Conclusions: In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation.

scholarly journals Current Applications for the Use of Extracorporeal Carbon Dioxide Removal in Critically Ill Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Luigi Camporota ◽  
Nicholas Barrett
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Injury ◽  
Carbon Dioxide Removal ◽  
Extracorporeal Carbon Dioxide Removal ◽  
Ventilator Induced Lung Injury ◽  
Patient Groups ◽  
Protective Mechanical Ventilation

Mechanical ventilation in patients with respiratory failure has been associated with secondary lung injury, termed ventilator-induced lung injury. Extracorporeal venovenous carbon dioxide removal (ECCO2R) appears to be a feasible means to facilitate more protective mechanical ventilation or potentially avoid mechanical ventilation in select patient groups. With this expanding role of ECCO2R, we aim to describe the technology and the main indications of ECCO2R.

Arteriovenous Extracorporeal Carbon Dioxide Removal A Mathematical Model and Experimental Evaluation

ASAIO Journal ◽  
1998 ◽  
Vol 44 (4) ◽  
pp. 267-277 ◽  
Author(s):  
STEVEN A. CONRAD ◽  
EEDWIN G. BROWN ◽  
LAURIE R. GRIER ◽  
JOHN BAIER ◽  
JANET BLOUNT ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mathematical Model ◽  
Experimental Evaluation ◽  
Carbon Dioxide Removal ◽  
Extracorporeal Carbon Dioxide Removal

scholarly journals Application of extracorporeal carbon dioxide removal combined with continuous blood purification therapy in ARDS with hypercapnia in patients with critical COVID-19

2021 ◽  
pp. 1-9
Author(s):  
Ye Chen ◽  
Shouhong Wang ◽  
Jianrong Huang ◽  
Yingyun Fu ◽  
Juanmin Wen ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Lung Injury ◽  
Tidal Volume ◽  
Respiratory Acidosis ◽  
Blood Purification ◽  
Carbon Dioxide Removal ◽  
Extracorporeal Carbon Dioxide Removal ◽  
Blood Purification Therapy ◽  
Continuous Blood Purification

INTRODUCTION: Coronavirus disease-19 (COVID-19) is a new type of epidemic pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The population is generally susceptible to COVID-19, which mainly causes lung injury. Some cases may develop severe acute respiratory distress syndrome (ARDS). Currently, ARDS treatment is mainly mechanical ventilation, but mechanical ventilation often causes ventilator-induced lung injury (VILI) accompanied by hypercapnia in 14% of patients. Extracorporeal carbon dioxide removal (ECCO2R) can remove carbon dioxide from the blood of patients with ARDS, correct the respiratory acidosis, reduce the tidal volume and airway pressure, and reduce the incidence of VILI. CASE REPORT: Two patients with critical COVID-19 combined with multiple organ failure undertook mechanical ventilation and suffered from hypercapnia. ECCO2R, combined with continuous renal replacement therapy (CRRT), was conducted concomitantly. In both cases (No. 1 and 2), the tidal volume and positive end-expiratory pressure (PEEP) were down-regulated before the treatment and at 1.5 hours, one day, three days, five days, eight days, and ten days after the treatment, together with a noticeable decrease in PCO2 and clear increase in PO2, while FiO2 decreased to approximately 40%. In case No 2, compared with the condition before treatment, the PCO2 decreased significantly with down-regulation in the tidal volume and PEEP and improvement in the pulmonary edema and ARDS after the treatment. CONCLUSION: ECCO2R combined with continuous blood purification therapy in patients with COVID-19 who are criti-cally ill and have ARDS and hypercapnia might gain both time and opportunity in the treatment, down-regulate the ventilator parameters, reduce the incidence of VILI and achieve favorable therapeutic outcomes.

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