Evaluation of CO 2 removal rate of ECCO 2 R for a renal replacement therapy platform in an experimental setting.

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    • Source:
      Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 7802778 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1594 (Electronic) Linking ISSN: 0160564X NLM ISO Abbreviation: Artif Organs Subsets: MEDLINE
    • Publication Information:
      Publication: Cambridge, MA : Wiley-Blackwell
      Original Publication: Cleveland, International Society for Artificial Organs.
    • Subject Terms:
    • Abstract:
      Background: A critical parameter of extracorporeal CO 2 removal (ECCO 2 R) applications is the CO 2 removal rate (VCO 2 ). Low-flow venovenous extracorporeal support with large-size membrane lung remains undefined. This study aimed to evaluate the VCO 2 of a low-flow ECCO 2 R with large-size membrane lung using a renal replacement therapy platform in an experimental animal model.
      Methods: Twelve healthy pigs were placed under mechanical ventilation and connected to an ECCO 2 R-CRRT system (surface area = 1.8 m 2 ; OMNIset®, BBraun, Germany). Respiratory settings were reduced to induce two degrees of hypercapnia. VCO 2 was recorded under different combinations of PaCO 2 (50-69 or 70-89 mm Hg), extracorporeal blood flow (ECBF; 200 or 350 mL/min), and gas flow (4, 6, or 10 L/min).
      Results: VCO 2 increased with ECBF at all three gas flow rates. In severe hypercapnia, the increase in sweep gas flow from 4 to 10 L/min increased VCO 2 from 86.38 ± 7.08 to 96.50 ± 8.71 mL/min at an ECBF of 350 mL/min, whereas at ECBF of 200 mL/min, any increase was less effective. But in mild hypercapnia, the increase in sweep gas flow result in significantly increased VCO 2 at two ECBF. VCO 2 increased with PaCO 2 from 50-69 to 70-89 mm Hg at an ECBF of 350 mL/min, but not at ECBF of 200 mL/min. Post-membrane lung PCO 2 levels were similar for different levels of premembrane lung PCO 2 (p = 0.08), highlighting the gas exchange diffusion efficacy of the membrane lung in gas exchange diffusion. In severe hypercapnia, the reduction of PaCO 2 elevated from 11.5% to 19.6% with ECBF increase only at a high gas flow of 10 L/min (p < 0.05) and increase of gas flow significantly reduced PaCO 2 only at a high ECBF of 350 mL/min (p < 0.05).
      Conclusions: Low-flow venovenous extracorporeal ECCO 2 R-CRRT with large-size membrane lung is more efficient with the increase of ECBF, sweep gas flow rate, and the degree of hypercapnia. The influence of sweep gas flow on VCO 2 depends on the ECBF and degree of hypercapnia. Higher ECBF and gas flow should be chosen to reverse severe hypercapnia.
      (© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
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    • Grant Information:
      2022YFC2504405 National Key R&D Program of China; BE2020786 Clinical Science and Technology Specific Projects of Jiangsu Province; 82270083 National Natural Science Foundation of China; 81870066 National Natural Science Foundation of China; LGY2022025 Second Level Talents of the "333 High Level Talents Training Project" in the sixth phase in Jiangsu; ZDXYS202205 Jiangsu Provincial Medical Key Laboratory; BBraun
    • Contributed Indexing:
      Keywords: extracorporeal blood flow; extracorporeal carbon dioxide removal; gas flow rate; hypercapnia
    • Publication Date:
      Date Created: 20240202 Date Completed: 20240520 Latest Revision: 20240520
    • Publication Date:
      20240520
    • Accession Number:
      10.1111/aor.14718
    • Accession Number:
      38304926