Abstract
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.
Highlights
Significant advancements have been done to understand the feasibility and safety of extracorporeal CO2 removal (ECCO2R) in patients with hypoxemic and/or hypercapnic respiratory failure [1,2,3,4]
ECCO2R has been used either to reduce the main components of the mechanical power, which may potentially cause ventilator-induced lung injury (VILI) in patients with severe acute respiratory distress syndrome (ARDS) [5], or, to avoid endotracheal intubation and invasive mechanical ventilation in patients failing non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease (COPD) or of end-stage respiratory disease awaiting for a lung transplant [3,4,5,6,7]
With the present study conducted in healthy pigs, we aimed to describe the CO2 removal performance and operational characteristics of a new medium-flow ECCO2R device, which has been created for CO2 removal using a fixed amount of blood flow rate, a membrane lung of 1.8 m2 and different sweep gas flow rates
Summary
Significant advancements have been done to understand the feasibility and safety of extracorporeal CO2 removal (ECCO2R) in patients with hypoxemic and/or hypercapnic respiratory failure [1,2,3,4]. ECCO2R has been used either to reduce the main components of the mechanical power (i.e., respiratory rate, driving pressure, flow rate and/or positive end expiratory pressure), which may potentially cause ventilator-induced lung injury (VILI) in patients with severe acute respiratory distress syndrome (ARDS) [5], or, to avoid endotracheal intubation and invasive mechanical ventilation in patients failing non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease (COPD) or of end-stage respiratory disease awaiting for a lung transplant [3,4,5,6,7] For these purposes, several devices have been developed (i.e., pumpless arterio-venous or pump-driven venovenous circuits), using a varying range of blood flow (i.e., from 200 to 1800 mL/min), sweep gas flow and different sizes (m2) of membrane lungs. 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
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