Decreasing pulmonary ventilation through bicarbonate ultrafiltration: An experimental study
- 1 September 2009
- journal article
- laboratory investigations
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 37 (9), 2612-2618
- https://doi.org/10.1097/ccm.0b013e3181a5668a
Abstract
Objective: To demonstrate the technical feasibility of CO2 removal with a commercial hemofilter and a replacement solution containing sodium hydroxide to replace bicarbonate. Design: Prospective animal experiment in sheep. Subjects: Seven mixed-breed female sheep. Interventions: Blood ultrafiltrate containing half of the metabolic production of CO2 was removed with a commercial hemofilter and a replacement solution containing sodium hydroxide was given as replacement. Minute ventilation was lowered to less than half of its baseline value. Ultrafiltration was stopped at 18 hrs, and Paco2 was allowed to increase for about 1 hr; at this time, the sheep were electively killed. Measurements and Main Results: Every 6 hrs, blood was sampled from the carotid artery, the pulmonary artery, and from the extracorporeal perfusion circuit (before the hemofilter, immediately after the hemofilter, and after mixing with the replacement solution). To maintain normocapnia, minute ventilation was reduced from 3.8 ± 0.1 L/min to 1.9 ± 0.7 L/min; Paco2 remained near constant during the study. The average blood pH, after mixing with the replacement solution, was 7.64 ± 0.12. One hour after the ultrafiltration had stopped, Paco2 had increased from 36.7 ± 4.2 torr (4.9 ± 0.6 kPa) to 59.6 ± 9 torr (7.9 ± 1.2 kPa) (p < .01) and blood pH had decreased from 7.317 ± 0.041 to 7.151 ± 0.051 (p < .01). Conclusion: CO2 removal with bicarbonate ultrafiltration may be an effective treatment for patients with respiratory failure.This publication has 26 references indexed in Scilit:
- Lung Recruitment in Patients with the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2006
- The concept of “baby lung”Intensive Care Medicine, 2005
- Permissive hypercapnia — role in protective lung ventilatory strategiesIntensive Care Medicine, 2004
- Physical and biological triggers of ventilator-induced lung injury and its preventionEuropean Respiratory Journal, 2003
- Effect of Mechanical Ventilation on Inflammatory Mediators in Patients With Acute Respiratory Distress SyndromeJAMA, 1999
- Mechanical Ventilation Affects Local and Systemic Cytokines in an Animal Model of Acute Respiratory Distress SyndromeAmerican Journal of Respiratory and Critical Care Medicine, 1999
- Multiple System Organ FailureAmerican Journal of Respiratory and Critical Care Medicine, 1998
- Severe Acute Respiratory Failure Managed with Continuous Positive Airway Pressure and Partial Extracorporeal Carbon Dioxide Removal by an Artificial Membrane Lung: A Controlled, Randomized Animal StudyAmerican Review of Respiratory Disease, 1988
- An alternative to breathingThe Journal of Thoracic and Cardiovascular Surgery, 1978
- ACUTE RESPIRATORY DISTRESS IN ADULTSThe Lancet, 1967