Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis
Abstract Background Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m2. The present stu...
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doaj-a4ed6403672f4977bf1343b6207d5f1f2020-11-24T21:35:03ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2017-08-015111310.1186/s40635-017-0147-0Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosisChristian Karagiannidis0Stephan Strassmann1Daniel Brodie2Philine Ritter3Anders Larsson4Ralf Borchardt5Wolfram Windisch6Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDivision of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons/New York-Presbyterian HospitalEnmodes GmbHHedenstierna Laboratory, Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala UniversityEnmodes GmbHDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalAbstract Background Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m2. The present study in an animal model with similar CO2 production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO2R. Methods Four different membrane lungs, with varying lung surface areas of 0.4, 0.8, 1.0, and 1.3m2 were used to perform vv-ECCO2R in seven anesthetized, mechanically ventilated, pigs with experimentally induced severe respiratory acidosis (pH 7.0–7.1) using a 20Fr double-lumen catheter with a sweep gas flow rate of 8 L/min. During each experiment, the blood flow was increased stepwise from 250 to 1000 ml/min. Results Amelioration of severe respiratory acidosis was only feasible when blood flow rates from 750 to 1000 ml/min were used with a membrane lung surface area of at least 0.8 m2. Maximal CO2 elimination was 150.8 ml/min, with pH increasing from 7.01 to 7.30 (blood flow 1000 ml/min; membrane lung 1.3 m2). The membrane lung with a surface of 0.4 m2 allowed a maximum CO2 elimination rate of 71.7 mL/min, which did not result in the normalization of pH, even with a blood flow rate of 1000 ml/min. Also of note, an increase of the surface area above 1.0 m2 did not result in substantially higher CO2 elimination rates. The pressure drop across the oxygenator was considerably lower (<10 mmHg) in the largest membrane lung, whereas the smallest revealed a pressure drop of more than 50 mmHg with 1000 ml blood flow/min. Conclusions In this porcine model, vv-ECCO2R was most effective when using blood flow rates ranging between 750 and 1000 ml/min, with a membrane lung surface of at least 0.8 m2. In contrast, low blood flow rates (250–500 ml/min) were not sufficient to completely correct severe respiratory acidosis, irrespective of the surface area of the membrane lung being used. The converse was also true, low surface membrane lungs (0.4 m2) were not capable of completely correcting severe respiratory acidosis across the range of blood flows used in this study.http://link.springer.com/article/10.1186/s40635-017-0147-0ECMOECCO2RSevere COPDExacerbationAsthmaRenal replacement therapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christian Karagiannidis Stephan Strassmann Daniel Brodie Philine Ritter Anders Larsson Ralf Borchardt Wolfram Windisch |
spellingShingle |
Christian Karagiannidis Stephan Strassmann Daniel Brodie Philine Ritter Anders Larsson Ralf Borchardt Wolfram Windisch Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis Intensive Care Medicine Experimental ECMO ECCO2R Severe COPD Exacerbation Asthma Renal replacement therapy |
author_facet |
Christian Karagiannidis Stephan Strassmann Daniel Brodie Philine Ritter Anders Larsson Ralf Borchardt Wolfram Windisch |
author_sort |
Christian Karagiannidis |
title |
Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis |
title_short |
Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis |
title_full |
Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis |
title_fullStr |
Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis |
title_full_unstemmed |
Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis |
title_sort |
impact of membrane lung surface area and blood flow on extracorporeal co2 removal during severe respiratory acidosis |
publisher |
SpringerOpen |
series |
Intensive Care Medicine Experimental |
issn |
2197-425X |
publishDate |
2017-08-01 |
description |
Abstract Background Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m2. The present study in an animal model with similar CO2 production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO2R. Methods Four different membrane lungs, with varying lung surface areas of 0.4, 0.8, 1.0, and 1.3m2 were used to perform vv-ECCO2R in seven anesthetized, mechanically ventilated, pigs with experimentally induced severe respiratory acidosis (pH 7.0–7.1) using a 20Fr double-lumen catheter with a sweep gas flow rate of 8 L/min. During each experiment, the blood flow was increased stepwise from 250 to 1000 ml/min. Results Amelioration of severe respiratory acidosis was only feasible when blood flow rates from 750 to 1000 ml/min were used with a membrane lung surface area of at least 0.8 m2. Maximal CO2 elimination was 150.8 ml/min, with pH increasing from 7.01 to 7.30 (blood flow 1000 ml/min; membrane lung 1.3 m2). The membrane lung with a surface of 0.4 m2 allowed a maximum CO2 elimination rate of 71.7 mL/min, which did not result in the normalization of pH, even with a blood flow rate of 1000 ml/min. Also of note, an increase of the surface area above 1.0 m2 did not result in substantially higher CO2 elimination rates. The pressure drop across the oxygenator was considerably lower (<10 mmHg) in the largest membrane lung, whereas the smallest revealed a pressure drop of more than 50 mmHg with 1000 ml blood flow/min. Conclusions In this porcine model, vv-ECCO2R was most effective when using blood flow rates ranging between 750 and 1000 ml/min, with a membrane lung surface of at least 0.8 m2. In contrast, low blood flow rates (250–500 ml/min) were not sufficient to completely correct severe respiratory acidosis, irrespective of the surface area of the membrane lung being used. The converse was also true, low surface membrane lungs (0.4 m2) were not capable of completely correcting severe respiratory acidosis across the range of blood flows used in this study. |
topic |
ECMO ECCO2R Severe COPD Exacerbation Asthma Renal replacement therapy |
url |
http://link.springer.com/article/10.1186/s40635-017-0147-0 |
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