Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep

Abstract

Introduction Extracorporeal lung assist, an extreme resource in patients with acute respiratory failure (ARF), is expanding its indications since knowledge about ventilator-induced lung injury has increased and protective ventilation has become the standard in ARF.

Safety and Efficacy of Combined Extracorporeal CO2 Removal and Renal Replacement Therapy in Patients With Acute Respiratory Distress Syndrome and Acute Kidney Injury

“…Using a standardized protocol of ventilation based on the ARDS Net protocol, we were able to demonstrate that our combined RRT + ECC o 2 R system decreased arterial PC o 2 by 21%. This result is similar to that reported with the Decap system, performed at a lower blood flow (300 mL/min) ( 34 ). Although the magnitude of the Pa co 2 reduction is less impressive than in the study by Forster et al ( 35 ), the range of Pa co 2 observed in our study is markedly lower.…”

“…The primary endpoint was a 20% reduction in Pa co 2 at 20 minutes after ECC o 2 R initiation ( 34 ). With a mean Pa co 2 before ECC o 2 R of 50 ± 10 Torr, a sample of 10 patients would be required to detect a bilateral difference of 5% with a power of 80%.…”

Combination of Quantitative Capnometry, N-Terminal Pro-brain Natriuretic Peptide, and Clinical Assessment in Differentiating Acute Heart Failure from Pulmonary Disease as Cause of Acute Dyspnea in Pre-hospital Emergency Setting: Study of Diagnostic Accuracy

“…Physical examination, chest radiography, electrocardiography, and standard biological tests often fail to accurately differentiate heart failure (HF) from pulmonary causes of dyspnea (3). Timely differentiation of HF from other causes of dyspnea may permit the early institution of appropriate medical therapy (4)(5)(6). Brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) have been proposed as early markers of HF and demonstrated to be useful for diagnosing and excluding HF in emergency department (7)(8)(9).…”

Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future

“…Since ultrafiltrate contains dissolved CO 2 , recirculating in this way allows additional CO 2 removal by creating a greater flow rate through the membrane lung than the flow from the patient. Consequently, smaller membrane lungs can be used (0.3 to 1.35 m 2 ) with lower flow rates (<500 ml.minute -1 ) than conventional ECCOR [33], resulting in similar anticoagulation requirements to continuous venovenous hemodialysis [46]. The Decap has been successfully used in adults and children [9,47,48].…”