Hemodynamics and renal function during low frequency positive pressure ventilation with extracorporeal CO2 removal

Gattinoni, Luciano; Agostoni, A; Damia, G; Cantaluppi, D.; Bernasconi, C.; Tarenzi, L; Pelizzola, A.; Rossi, Gianpaolo

doi:10.1007/bf01757297

Cited by 31 publications

(2 citation statements)

References 28 publications

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“…ECCO2R combined with low frequency positive‐pressure ventilation is currently used at some ARDS centers to improve the gas exchange in the most severe ARDS cases (14–20). A trend to less invasive and less risky devices is clearly visible; a complete CO 2 removal was achieved when the blood flow was as low as 700 ml · min −1 (21,22).…”

Section: Discussionmentioning

confidence: 99%

Effects of Ultrafiltration, Dialysis, and Temperature on Gas Exchange During Hemodiafiltration: A Laboratory Experiment

Růžička¹,

Novák

Rokyta

et al. 2001

Artificial Organs

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To study gas exchange in the filter during continuous venovenous hemodiafiltration (CVVHDF), an air-tight heated mixing chamber with adjustable CO2 supply was constructed and connected to a CVVHDF monitor. Bicarbonate-free crystalloid (Part 1) and packed red blood cell (Part 2) solutions were circulated at 150 ml x min(-1). Gas exchange expressed as pre-postfilter difference in CO2 and O2 contents was measured at different CVVHDF settings and temperatures of circulating and dialysis solutions. Ultrafiltration was most efficacious for CO2 removal (at 1,000 ml x h(-1) ultrafiltration CO2 losses reached 13% of prefilter CO2 content). Addition of dialysis (1,000 ml x h(-1)) increased CO2 loss to 17% and at maximal parameters (filtration 3,000 ml x h(-1), dialysis 2,500 ml x h(-1)), the loss of CO2 amounted to 35% of prefilter content. Temperature changes of circulating and/or dialysis fluids had no significant impact on CO2 losses. The O2 exchange during CVVHDF was negligible. Currently used CVVHDF is only marginally effective in CO2 removal. Higher volume ultrafiltration combined with dialysis can be expected to reach clinical significance.

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Section: Discussionmentioning

confidence: 99%

Effects of Ultrafiltration, Dialysis, and Temperature on Gas Exchange During Hemodiafiltration: A Laboratory Experiment

Růžička¹,

Novák

Rokyta

et al. 2001

Artificial Organs

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“…They suggested the possibility of removing COZ with this device and providing oxygenation with reduced ventilatory rates, thus optimizing the chances of lung recovery while providing adequate gas exchange. Further developments of this technique (20)(21)(22)(23)(24)(25) have shown that ADO can be safely performed for many days when metabolic CO2 is removed by an extracorporeal membrane lung (ECCOZR) and 100% 0 2 is supplied directly into the trachea keeping intrapulmonary pressures at 5 cmH2O (0.5 kPa). Increasing the continuous airway pressure (P,) to 20 cmH20 (2 kPa) was shown to reduce shunt, and improve oxygenation, funtional residual capacity (FRC) and compliance (22).…”

Section: Apneic Dafusion Oxygenation and Continuousjow Apneic Ventilamentioning

confidence: 99%

Apneic Diffusion Oxygenation and Continuous Flow Apneic Ventilation. A Review

Smith¹,

Sjöstrand²

1985

Acta Anaesthesiol Scand

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Evolution of life coincides with the most rapid rate of rise in atmospheric oxygen concentration during Devonian time. Oxygen is essential for life, but at the same time is a cellular poison if present in tensions considerably higher than those the particular cellular milieu has become adapted to. Animals exposed to low oxygen tensions breathe continuously, e.g. most species of fish obtain their oxygen from a continuous flow of water at low oxygen tensions. Evolution from water to land breathing generally is associated with intermittent breathing, mass movement of gas in one direction, i.e. inhalation and exhalation. Intermittent breathing is part of this evolutionary process and reduces the inspired oxygen tension from 150 mmHg (19.95 kPa) to approximately 100 mmHg (13.3 kPa) at the alveolar blood interface. Perhaps evolution from continuous ventilation to intermittent breathing may be protecting the body against the high atmospheric oxygen tension. Therefore, it is not surprising that mammals can have adequate oxygen uptake with apneic diffusion oxygenation (ADO) and continuous flow apneic ventilation (CFAV). Mechanical ventilation classic techniques, i.e. intermittent positive-pressure ventilation and continuous positive-pressure ventilation, employ ventilatory frequencies close to the resting breathing rate of the adult. Utilizing low-compression patient circuits has made mechanical ventilation with higher frequencies possible. 60 to 400 breaths per min is used for high-frequency positive-pressure ventilation and high-frequency jet ventilation, and up to 40 Hz is used for high-frequency oscillation (HFO). The two extremes of artificial ventilation - ADO, i.e. supply of O2 by continuous flow, and HFO, i.e. supply of O2 by oscillatory changes - both primarily involve diffusion, even though convection (also secondary to cardiac oscillations) obviously is important in the process of gas exchange. Some recent experimental findings favor continued development and evaluation of CFAV as an additional alternative to artificial ventilation.

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Extracorporeal Respiratory Support

Pesenti¹

1998

Update in Intensive Care and Emergency Medicine

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Hemodynamics and renal function during low frequency positive pressure ventilation with extracorporeal CO2 removal

Cited by 31 publications

References 28 publications

Effects of Ultrafiltration, Dialysis, and Temperature on Gas Exchange During Hemodiafiltration: A Laboratory Experiment

Effects of Ultrafiltration, Dialysis, and Temperature on Gas Exchange During Hemodiafiltration: A Laboratory Experiment

Apneic Diffusion Oxygenation and Continuous Flow Apneic Ventilation. A Review

Extracorporeal Respiratory Support

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