Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation

Kluge, Stefan; Braune, Stephan; Engel, Markus; Nierhaus, Axel; Frings, Daniel; Ebelt, Henning; Uhrig, Alexander; Metschke, Maria; Wegscheider, Karl; Suttorp, Norbert; Rousseau, Simone

doi:10.1007/s00134-012-2649-2

Cited by 173 publications

(117 citation statements)

References 30 publications

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“…[17]. ECCO2-R ist möglicherweise in der Lage, bei einem Teil der Patienten mit AECOPD eine Intubation zu verhindern [6,22]. Der Nachweis einer dadurch erreichten Verbesserung der Prognose wurde bis dato allerdings nicht erbracht.…”

Section: Erweiterung Des Spektrums Differenzierte Konfigurationunclassified

Extrakorporale Lungenersatzverfahren – was gibt es Neues, was kommt?

Staudinger

2016

Med Klin Intensivmed Notfmed

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Section: Erweiterung Des Spektrums Differenzierte Konfigurationunclassified

Extrakorporale Lungenersatzverfahren – was gibt es Neues, was kommt?

Staudinger

2016

Med Klin Intensivmed Notfmed

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“…Recent applications of CO 2 removal have been aimed at low invasiveness, through low extracorporeal blood flows (10,11). With current technology this approach may be limited by a relatively low amount of CO 2 removal (12)(13)(14)(15). We aimed at significantly increasing the amount of CO 2 removed from a given blood flow, so as to achieve a greater decrease of ventilation and expand the spectrum of potential clinical applications (16)(17)(18).…”

Section: At a Glance Commentarymentioning

confidence: 99%

Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO₂ Removal Technique

Zanella

Castagna

Salerno

et al. 2015

Am J Respir Crit Care Med

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Rationale: We developed an innovative, minimally invasive, highly efficient extracorporeal CO 2 removal (ECCO 2 R) technique called respiratory electrodialysis (R-ED).Objectives: To evaluate the efficacy of R-ED in controlling ventilation compared with conventional ECCO 2 R technology.Methods: Five mechanically ventilated swine were connected to a custom-made circuit optimized for R-ED, consisting of a hemofilter, a membrane lung, and an electrodialysis cell. Electrodialysis regionally modulates blood electrolyte concentration to convert bicarbonate to CO 2 before entering the membrane lung, enhancing membrane lung CO 2 extraction. All animals underwent three repeated experimental sequences, consisting of four steps: baseline (1 h), conventional ECCO 2 R (2 h), R-ED (2 h), and final NO-ECCO 2 R (1 h). Blood and gas flow were 250 ml/min and 10 L/min, respectively. Tidal volume was set at 8 ml/kg, and respiratory rate was adjusted to maintain arterial PCO 2 at 50 mm Hg.Measurements and Main Results: During R-ED, chloride and H 1 concentration increased in blood entering the membrane lung, almost doubling CO 2 extraction compared with ECCO 2 R (112 6 6 vs. 64 6 5 ml/min, P , 0.001). Compared with baseline, R-ED and ECCO 2 R reduced minute ventilation by 50% and 27%, respectively. Systemic arterial gas analyses remained stable during the experimental phases. No major complication occurred, but there was an increase in creatinine level.Conclusions: In this first in vivo application, we proved electrodialysis feasible and effective in increasing membrane lung CO 2 extraction. R-ED was more effective than conventional ECCO 2 R technology in controlling ventilation. Further studies are warranted to assess the safety profile of R-ED, especially regarding kidney function.Keywords: extracorporeal circulation; carbon dioxide; respiratory insufficiency; hypercapnia At a Glance CommentaryScientific Knowledge on the Subject: Extracorporeal CO 2 removal (ECCO 2 R) has been suggested for the treatment of patients with acute and chronic respiratory failure. The current ECCO 2 R technology, although perfected compared to the past, still has room for improvement.What This Study Adds to the Field: We developed respiratory electrodialysis, an innovative extracorporeal CO 2 removal technique that selectively modulates pH and electrolyte concentration and highly enhances CO 2 removal by applying an electrical field to blood. Respiratory electrodialysis, requiring a minimally invasive approach, could greatly affect the way we treat patients suffering from respiratory failure and other conditions.

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“…Low-flow VV ECMO systems with smaller cannulas and gas exchange modules are becoming established as an alternative. For selected patient groups with high mortality risk following intubation, extracorporeal procedures are used on an individual basis to avoid invasive ventilation (35)(36)(37). There is no evidence as yet that extracorporeal carbon dioxide removal improves survival rates or reduces the duration of ventilation.…”

Section: Adverse Effects and Risksmentioning

confidence: 99%