Extracorporeal carbon dioxide removal with continuous renal replacement therapy.
            Case description and literature review

López-Sánchez, Maite; Rubio-Lopez, María I.

doi:10.5935/0103-507x.20200020

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…7,8 Thus, there exists a medical need for combined lung and kidney support, and previous work has shown that ECCO 2 R and continuous KRT can be performed in a single extracorporeal circuit when these devices are placed in series. [9][10][11] The use of such systems may have significant clinical advantages, 12 particularly for vascular access considerations 13 ; one such system that can be applied with the use of a single vascular access site has been available commercially (PrismaLung, Baxter, Deerfield, IL, USA).…”

Section: Introductionmentioning

confidence: 99%

Modeling acid‐base balance for in‐series extracorporeal carbon dioxide removal and continuous venovenous hemofiltration devices

et al. 2021

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Patients with acute respiratory distress syndrome and acute kidney injury (AKI) treated by kidney replacement therapy may also require treatment with extracorporeal carbon dioxide removal (ECCO2R) devices to permit protective or ultraprotective mechanical ventilation. We developed a mathematical model of acid‐base balance during extracorporeal therapy using ECCO2R and continuous venovenous hemofiltration (CVVH) devices applied in series for the treatment of mechanically ventilated AKI patients. Published data from clinical studies of mechanically ventilated AKI patients treated by CVVH at known infusion rates of substitution fluid without ECCO2R were used to adjust the model parameters to fit plasma levels of arterial partial pressure of carbon dioxide (PaCO2), arterial plasma bicarbonate concentration ([HCO3]), and plasma pH (as well as certain other unmeasured physiological variables). The effects of applying ECCO2R at an unchanged and a reduced tidal volume on PaCO2, [HCO3] and plasma pH were then simulated assuming carbon dioxide removal rates from the ECCO2R device measured in the clinical studies. Agreement of such model predictions with clinical data was good whether the ECCO2R device was positioned proximal or distal to the CVVH device in the extracorporeal circuit. Although carbon dioxide removal rates from the ECCO2R device measured in one previous clinical study were higher when it was placed proximal to the CVVH device, suggesting that such in‐series positioning was optimal, the current mathematical model demonstrates that proximal positioning of the ECCO2R device also results in lower bicarbonate (and, therefore, total carbon dioxide) removal from the distal CVVH device. Thus, the removal of total carbon dioxide by such extracorporeal circuits is relatively independent of the position of the in‐series devices. It is concluded that the described mathematical model has quantitative accuracy; these results suggest that the overall acid‐base balance when using ECCO2R and CVVH devices in a single extracorporeal circuit will be similar, independent of their in‐series position.

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Section: Introductionmentioning

confidence: 99%

Modeling acid‐base balance for in‐series extracorporeal carbon dioxide removal and continuous venovenous hemofiltration devices

et al. 2021

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“…However, the ADVOS device does not provide complete lung support like in ECMO devices, since blood oxygenation is not supported, and CO 2 elimination is limited. Furthermore, the combination of minimal-flow carbon dioxide removal (ECCO 2 R) systems and CRRT has been reported (114)(115)(116) This device demonstrates that combining lung and kidney support is associated with important benefits, however, challenges including fiber arrangement, modulation of gas transfer and fluid filtration, device miniaturization, and precise anticoagulation regimen still have to be further addressed.…”

Section: Combined Lung and Kidney Support In A Single Extracorporeal ...mentioning

confidence: 99%

“…However, the ADVOS device does not provide complete lung support like in ECMO devices, since blood oxygenation is not supported, and CO 2 elimination is limited. Furthermore, the combination of minimal-flow carbon dioxide removal (ECCO 2 R) systems and CRRT has been reported ( 114 – 116 ). Terragni et al ( 114 ) and Moerer et al ( 115 ) applied a CRRT-ECCO 2 R device [EQUA-smart®, Hemodec (MEDIA), Modena; Italy] to support mechanically ventilated patients.…”

Section: Technical Outlookmentioning

confidence: 99%

Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View

Costa

Halfwerk

Wiegmann

et al. 2022

Front. Med. Technol.

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Extracorporeal membrane oxygenation (ECMO) provides pulmonary and/or cardiac support for critically ill patients. Due to their diseases, they are at high risk of developing acute kidney injury. In that case, continuous renal replacement therapy (CRRT) is applied to provide renal support and fluid management. The ECMO and CRRT circuits can be combined by an integrated or parallel approach. So far, all methods used for combined extracorporeal lung and kidney support present serious drawbacks. This includes not only high risks of circuit related complications such as bleeding, thrombus formation, and hemolysis, but also increase in technical workload and health care costs. In this sense, the development of a novel optimized artificial lung device with integrated renal support could offer important treatment benefits. Therefore, we conducted a review to provide technical background on existing techniques for extracorporeal lung and kidney support and give insight on important aspects to be addressed in the development of this novel highly integrated artificial lung device.

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“…In a recently published consensus, 40 A clever approach is to apply ECCO 2 R and CRRT integrating both extracorporeal circuits. 4,41 Fourth-generation CRRT machines 1 are prepared for this strategy and the stewardship of a dedicated perfusionist is not required. Recently, Jonckheer et al, demonstrated that RCA for CRRT is not associated with worsening in PaCO 2 , since CO 2 generated in the Krebs cycle from citrate metabolism is rapidly swept from the blood during its passage through the dialyzer.…”

Section: E X Tr Acorp Ore Al C Arbon Dioxide Removalmentioning

confidence: 99%

“…As a means to provide ultra-protective ventilation, 39,40 extracorporeal carbon dioxide removal (ECCO 2 R) was started using a combined ECCO 2 R-CRRT system. 4,41 The dialysis membrane applied was able to remove both cytokines and endotoxins. [42][43][44][45] In parallel and through another venous access, hemoperfusion for endotoxin removal [46][47][48][49][50] was carried out for 2 h, followed by hemoperfusion for cytokine removal [51][52][53] for 12 h, in two consecutive days.…”

mentioning

confidence: 99%

Continuous renal replacement therapy and extended indications

Ronco

Reis

2021

Seminars in Dialysis

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Initially developed to replace kidney function in severely ill newborns/infants, and then diverted to severely ill adult patients, 1 continuous renal replacement therapy (CRRT) is now applied to support different organs apart from the kidney in a myriad of clinical conditions such as sepsis, 2 acute liver failure (ALF), 3 acute respiratory distress syndrome (ARDS), 4-6 and cardiogenic shock. 7 The extended indications for CRRT and the concept of sequential extracorporeal therapies 8 are intrinsically related. The individualization of care and selection of treatment candidates based on clinical and molecular phenotypes increases the probability of benefit for each of the proposed blood purification techniques 9-15 (Figure 1).In sepsis, the removal of damage-associated molecular patterns (e.g. cytokines) and pathogen-associated molecular patterns (e.g. endotoxins) might reduce the burden of the disease. 16 In liver failure, CRRT reduces the risk of ammonia-related neurotoxicity while artificial liver support systems effectively reduce bilirubin and bile acids concentrations. 3 In ARDS, extracorporeal CO 2 removal (ECCO 2 R) allows the application of ultra-protective ventilation avoiding deleterious consequences of hypercapnia and reducing the risk of ventilator-associated lung injury. [17][18][19] In cardiogenic shock and cardiac surgery in which shifts in fluid balance are poorly tolerated, CRRT might mitigate further myocardial damage. 20,21

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Extracorporeal carbon dioxide removal with continuous renal replacement therapy. Case description and literature review

Cited by 3 publications

References 18 publications

Modeling acid‐base balance for in‐series extracorporeal carbon dioxide removal and continuous venovenous hemofiltration devices

Modeling acid‐base balance for in‐series extracorporeal carbon dioxide removal and continuous venovenous hemofiltration devices

Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View

Continuous renal replacement therapy and extended indications

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