Modern and traditional approaches combined into an effective gray-box mathematical model of full-blood acid-base

Ježek, Filip; Kofránek, Jiří

doi:10.1186/s12976-018-0086-9

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…The mathematical model of acid‐base chemistry of blood used in this work is complex, but it cannot describe all chemical changes within the blood of all the body compartments or extracorporeal circuits considered here. For that purpose, more complex models of blood chemistry that include other electrolytes would likely be required 24,25 . Furthermore, the model of pulmonary gas exchange in the current work is likely too simple to provide exact quantitative accuracy with physiological reality; this is exemplified by the necessity to assume higher rates of tissue CO 2 production rates than are typical and those measured in clinical studies (see Tables 1 and 3).…”

Section: Discussionmentioning

confidence: 99%

“…For that purpose, more complex models of blood chemistry that include other electrolytes would likely be required. 24,25 Furthermore, the model of pulmonary gas exchange in the current work is likely too simple to provide exact quantitative accuracy with physiological reality; this is exemplified by the necessity to assume higher rates of tissue CO 2 production rates than are typical and those measured in clinical studies (see Tables 1 and 3). More complex models of gas exchange have been developed, 26 but it is unlikely that the use of such models would alter the conclusions from this study.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%