| Respiratory dialysis: reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal. | |
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MedLine Citation:
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PMID: 21317644 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Mechanical ventilation is injurious to the lung. Use of lung-protective strategies may complicate patient management, motivating a search for better lung-replacement approaches. We investigated the ability of a novel extracorporeal venovenous CO2 removal device to reduce minute ventilation while maintaining normocarbia. DESIGN: Prospective animal study. SETTING: Government laboratory animal intensive care unit. SUBJECTS: Seven sedated swine. INTERVENTIONS: Tracheostomy, volume-controlled mechanical ventilation, and 72 hrs of round-the-clock intensive care unit care. A 15-F dual-lumen catheter was inserted in the external jugular vein and connected to the Hemolung, an extracorporeal pump-driven venovenous CO2 removal device. Minute ventilation was reduced, and normocarbia (Paco2 35-45 mm Hg) maintained. Heparinization was maintained at an activated clotting time of 150-180 secs. MEASUREMENTS AND MAIN RESULTS: Minute ventilation (L/min), CO2 removal by Hemolung (mL/min), Hemolung blood flow, O2 consumption (mL/min), CO2 production by the lung (mL/min), Paco2, and plasma-free hemoglobin (g/dL) were measured at baseline (where applicable), 2 hrs after device insertion, and every 6 hrs thereafter. Minute ventilation was reduced from 5.6 L/min at baseline to 2.6 L/min 2 hrs after device insertion and was maintained at 3 L/min until the end of the study. CO2 removal by Hemolung remained steady over 72 hrs, averaging 72 ± 1.2 mL/min at blood flows of 447 ± 5 mL/min. After insertion, O2 consumption did not change; CO2 production by the lung decreased by 50% and stayed at that level (p < .001). As the arterial PCO2 rose or fell, so did CO2 removal by Hemolung. Plasma-free hemoglobin did not change. CONCLUSIONS: Venovenous CO2 removal enabled a 50% reduction in minute ventilation while maintaining normocarbia and may be an effective lung-protective adjunct to mechanical ventilation. |
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Authors:
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Andriy I Batchinsky; Bryan S Jordan; Dara Regn; Corina Necsoiu; William J Federspiel; Michael J Morris; Leopoldo C Cancio |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: Critical care medicine Volume: 39 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-05-25 Completed Date: 2011-08-11 Revised Date: 2011-12-27 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1382-7 Citation Subset: AIM; IM |
Affiliation:
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US Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA. andriy.batchinsky@amedd.army.mil |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Carbon Dioxide / blood Catheterization, Central Venous Equipment Design Extracorporeal Circulation / instrumentation* Female Hemofiltration / instrumentation* Respiratory Insufficiency / blood, therapy* Swine Ventilator Weaning / instrumentation* |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2011 Jun;39(6):1576-7
[PMID:
21610632
]
Crit Care Med. 2011 Dec;39(12):2787-8; author reply 2788-9 [PMID: 22094525 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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