scholarly journals Evaluation of a New Extracorporeal CO2 Removal Device in an Experimental Setting

Membranes ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 8
Author(s):  
Matteo Di Nardo ◽  
Filippo Annoni ◽  
Fuhong Su ◽  
Mirko Belliato ◽  
Roberto Lorusso ◽  
...  
Keyword(s):  
Blood Flow ◽  
Gas Flow ◽  
High Surface ◽  
Surface Membrane ◽  
Respiratory Acidosis ◽  
Chronic Obstructive ◽  
Gas Flows ◽  
Co2 Removal ◽  
Extracorporeal Co2 Removal ◽  
Membrane Lung

Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO2 removal (ECCO2R). We tested the CO2 removal performance of a new ECCO2R (CO2RESET) device in an experimental animal model. Methods: Three healthy pigs were mechanically ventilated and connected to the CO2RESET device (surface area = 1.8 m2, EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO2 (target pre membrane lung venous PCO2 (PpreCO2): 80–120 mmHg). The amount of CO2 removed (VCO2, mL/min) by the membrane lung was assessed directly by the ECCO2R device. Results: Before the initiation of ECCO2R, the median PpreCO2 was 102.50 (95.30–118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO2 progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00–200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO2 was observed increasing the gas flow from 0 to 2 L/min, then, VCO2 tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed. Conclusions: Medium-flow ECCO2R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m2) provided a high VCO2 using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs.

scholarly journals Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis

2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Christian Karagiannidis ◽  
Stephan Strassmann ◽  
Daniel Brodie ◽  
Philine Ritter ◽  
Anders Larsson ◽  
...  
Keyword(s):  
Blood Flow ◽  
Surface Area ◽  
Respiratory Acidosis ◽  
Co2 Removal ◽  
Extracorporeal Co2 Removal ◽  
Membrane Lung ◽  
Lung Surface Area

Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: a proof-of-concept study

Thorax ◽  
2020 ◽  
Vol 75 (10) ◽  
pp. 897-900 ◽  
Author(s):  
Lara Pisani ◽  
Stefano Nava ◽  
Emilia Desiderio ◽  
Mario Polverino ◽  
Tommaso Tonetti ◽  
...  
Keyword(s):  
Time Window ◽  
Chronic Obstructive ◽  
Co2 Removal ◽  
Proof Of Concept ◽  
Invasive Ventilation ◽  
Extracorporeal Co2 Removal ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Carbon Dioxide Pressure

AbstractDomiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO2) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We hypothesised that extracorporeal CO2 removal (ECCO2R) may lower their PaCO2. Ten patients hypercapnic despite ≥6 months of NIV underwent a 24-hour trial of ECCO2R. Six patients completed the ECCO2R-trial with a PaCO2 drop ranging between 23% and 47%. Time to return to baseline after interruption ranged 48–96 hours. In four patients, mechanical events led to ECCO2R premature interruption, despite a decreased in PaCO2. This time window ‘free’ from hypercapnia might allow to propose the concept of ‘CO2 dialysis’.

Cardiac oscillations in expired gas tensions, and regional pulmonary blood flow

1961 ◽  
Vol 16 (5) ◽  
pp. 863-868 ◽  
Author(s):  
K. T. Fowler ◽  
John Read
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Gas Flow ◽  
Normal Subjects ◽  
Gas Mixture ◽  
Gas Flows ◽  
Blood Flows ◽  
Lower Lung ◽  
Expired Gas ◽  
Lying Down

Oscillations in expired gas tensions synchronous with the heartbeat were studied in detail following a tidal inspiration of a gas mixture containing 20.9% oxygen, 20% argon, and the rest nitrogen. A respiratory mass spectrometer continuously analyzed expired gas for argon, oxygen, and carbon dioxide. Simultaneous recordings of expiratory flow rate, expired volume, and electrocardiogram were made where necessary. The gas tension oscillations reflected pulsatile changes in gas flow from regions of different ventilations, blood flows, and Va/Qc ratios. An explanation for the oscillations was developed on the basis of cardiac-induced variations in relative gas flows from upper and lower zones of the lungs. This allowed the identification of these zones with the regions of different Va/Qc ratios, and the calculation of minimum differences in ventilation and blood flow between upper and lower lung zones. Blood flow in the upper lung zones of erect normal subjects was found to be very low, rising considerably on lying down. Three patients with raised left auricular pressures showed high upper zone blood flow in the erect position. Submitted on February 27, 1961

scholarly journals Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO2 clearance within the Maquet Quadrox-iD oxygenator

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 29-33 ◽  
Author(s):  
Bishoy Zakhary ◽  
Jayne Sheldrake ◽  
Vincent Pellegrino
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Dead Space ◽  
Gas Flow ◽  
Ex Vivo ◽  
Respiratory Acidosis ◽  
Gas Flows ◽  
Membrane Oxygenation ◽  
In Series ◽  
Membrane Oxygenators ◽  
Different Levels

While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO2 clearance within an adult Maquet Quadrox-iD oxygenator was evaluated at varying blood CO2 tensions and V/Q ratios in an ex vivo extracorporeal membrane oxygenation circuit. A closed blood-primed circuit incorporating two Maquet Quadrox-iD oxygenators in series was attached to a Maquet PLS Rotaflow pump. A varying blend of CO2 and air was connected to the first oxygenator to provide different levels of pre-oxygenator blood CO2 levels (PvCO2) to the second oxygenator. Varying sweep gas flows of 100% O2 were connected to the second oxygenator to provide different V/Q ratios. Exhaust CO2 was directly measured, and then VCO2 and oxygenator dead space fraction (VD/VT) were calculated. VCO2 increased with increasing gas flow rates with plateauing at V/Q ratios greater than 4.0. Exhaust CO2 increased with PvCO2 in a linear fashion with the slope of the line decreasing at high V/Q ratios. Oxygenator dead space fraction varied with V/Q ratio—at lower ratios, dead space fraction was 0.3-0.4 and rose to 0.8-0.9 at ratios greater than 4.0. Within the Maquet Quadrox-iD oxygenator, CO2 clearance is limited at high V/Q ratios and correlated with elevated oxygenator dead space fraction. These findings have important implications for patients requiring high levels of extracorporeal membrane oxygenation support.

scholarly journals Comparison of Circular and Parallel-Plated Membrane Lungs for Extracorporeal Carbon Dioxide Elimination

Membranes ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 398
Author(s):  
Leonie S. Schwärzel ◽  
Anna M. Jungmann ◽  
Nicole Schmoll ◽  
Stefan Caspari ◽  
Frederik Seiler ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Gas Flow ◽  
Removal Rate ◽  
Low Flow ◽  
Chronic Obstructive ◽  
Co2 Removal ◽  
Circular Membrane ◽  
Flow Rates ◽  
Polypropylene Membrane ◽  
Removal Capacity

Extracorporeal carbon dioxide removal (ECCO2R) is an important technique to treat critical lung diseases such as exacerbated chronic obstructive pulmonary disease (COPD) and mild or moderate acute respiratory distress syndrome (ARDS). This study applies our previously presented ECCO2R mock circuit to compare the CO2 removal capacity of circular versus parallel-plated membrane lungs at different sweep gas flow rates (0.5, 2, 4, 6 L/min) and blood flow rates (0.3 L/min, 0.9 L/min). For both designs, two low-flow polypropylene membrane lungs (Medos Hilte 1000, Quadrox-i Neonatal) and two mid-flow polymethylpentene membrane lungs (Novalung Minilung, Quadrox-iD Pediatric) were compared. While the parallel-plated Quadrox-iD Pediatric achieved the overall highest CO2 removal rates under medium and high sweep gas flow rates, the two circular membrane lungs performed relatively better at the lowest gas flow rate of 0.5 L/min. The low-flow Hilite 1000, although overall better than the Quadrox i-Neonatal, had the most significant advantage at a gas flow of 0.5 L/min. Moreover, the circular Minilung, despite being significantly less efficient than the Quadrox-iD Pediatric at medium and high sweep gas flow rates, did not show a significantly worse CO2 removal rate at a gas flow of 0.5 L/min but rather a slight advantage. We suggest that circular membrane lungs have an advantage at low sweep gas flow rates due to reduced shunting as a result of their fiber orientation. Efficiency for such low gas flow scenarios might be relevant for possible future portable ECCO2R devices.

scholarly journals Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations

Critical Care ◽  
2014 ◽  
Vol 18 (3) ◽  
pp. R124 ◽  
Author(s):  
Christian Karagiannidis ◽  
Kristin Kampe ◽  
Fernando Sipmann ◽  
Anders Larsson ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Respiratory Acidosis ◽  
Co2 Removal ◽  
Extracorporeal Co2 Removal ◽  
Technical Considerations

scholarly journals The use of extracorporeal CO2 removal in acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Raphaël Giraud ◽  
Carlo Banfi ◽  
Benjamin Assouline ◽  
Amandine De Charrière ◽  
Maurizio Cecconi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Cor Pulmonale ◽  
Alveolar Epithelial Cells ◽  
Chronic Obstructive ◽  
Co2 Removal ◽  
Copd Exacerbation ◽  
Lower Tidal Volume ◽  
Ventricular Afterload ◽  
Ultraprotective Ventilation

Abstract Background Chronic obstructive pulmonary disease (COPD) exacerbation and protective mechanical ventilation of acute respiratory distress syndrome (ARDS) patients induce hypercapnic respiratory acidosis. Main text Extracorporeal carbon dioxide removal (ECCO2R) aims to eliminate blood CO2 to fight against the adverse effects of hypercapnia and related acidosis. Hypercapnia has deleterious extrapulmonary consequences, particularly for the brain. In addition, in the lung, hypercapnia leads to: lower pH, pulmonary vasoconstriction, increases in right ventricular afterload, acute cor pulmonale. Moreover, hypercapnic acidosis may further damage the lungs by increasing both nitric oxide production and inflammation and altering alveolar epithelial cells. During an exacerbation of COPD, relieving the native lungs of at least a portion of the CO2 could potentially reduce the patient's respiratory work, Instead of mechanically increasing alveolar ventilation with MV in an already hyperinflated lung to increase CO2 removal, the use of ECCO2R may allow a decrease in respiratory volume and respiratory rate, resulting in improvement of lung mechanic. Thus, the use of ECCO2R may prevent noninvasive ventilation failure and allow intubated patients to be weaned off mechanical ventilation. In ARDS patients, ECCO2R may be used to promote an ultraprotective ventilation in allowing to lower tidal volume, plateau (Pplat) and driving pressures, parameters that have identified as a major risk factors for mortality. However, although ECCO2R appears to be effective in improving gas exchange and possibly in reducing the rate of endotracheal intubation and allowing more protective ventilation, its use may have pulmonary and hemodynamic consequences and may be associated with complications. Conclusion In selected patients, ECCO2R may be a promising adjunctive therapeutic strategy for the management of patients with severe COPD exacerbation and for the establishment of protective or ultraprotective ventilation in patients with ARDS without prognosis-threatening hypoxemia.

scholarly journals Continuous monitoring of membrane lung carbon dioxide removal during ECMO: experimental testing of a new volumetric capnometer

Perfusion ◽  
2019 ◽  
Vol 34 (7) ◽  
pp. 538-543 ◽  
Author(s):  
Alice Montalti ◽  
Mirko Belliato ◽  
Sandro Gelsomino ◽  
Sandro Nalon ◽  
Francesco Matteucci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Continuous Monitoring ◽  
Gas Flow ◽  
Carbon Dioxide Removal ◽  
Flow Ratio ◽  
Ml Estimation ◽  
New Device ◽  
Membrane Lung ◽  
Blood Flow Ratio

Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient–machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V′CO2ML), to help in estimating the oxygenator performance, in terms of CO2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO2RESET™, by Eurosets srl, Medolla, Italy) device was evaluated for V′CO2ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d − 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V′CO2ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V′CO2ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V′CO2ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V′CO2ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V′CO2ML showed strong correlation (rs = 0.991; p = 0.0005), as did VDsML calculations (rs = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.

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