Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R)
Abstract Background Veno-venous extracorporeal carbon dioxide (CO2) removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates range in clinical practice from 200 mL/min to more than 1500 mL/min, and sweep gas flow rates range from less than 1 to mor...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-03-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40635-019-0244-3 |
| _version_ | 1818249733923143680 |
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| author | Stephan Strassmann Michaela Merten Simone Schäfer Jonas de Moll Daniel Brodie Anders Larsson Wolfram Windisch Christian Karagiannidis |
| author_facet | Stephan Strassmann Michaela Merten Simone Schäfer Jonas de Moll Daniel Brodie Anders Larsson Wolfram Windisch Christian Karagiannidis |
| author_sort | Stephan Strassmann |
| collection | DOAJ |
| description | Abstract Background Veno-venous extracorporeal carbon dioxide (CO2) removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates range in clinical practice from 200 mL/min to more than 1500 mL/min, and sweep gas flow rates range from less than 1 to more than 10 L/min. The present porcine model study was aimed at determining the impact of varying sweep gas flow rates on CO2 removal under different blood flow conditions and membrane lung surface areas. Methods Two different membrane lungs, with surface areas of 0.4 and 0.8m2, were used in nine pigs with experimentally-induced hypercapnia. During each experiment, the blood flow was increased stepwise from 300 to 900 mL/min, with further increases up to 1800 mL/min with the larger membrane lung in steps of 300 mL/min. Sweep gas was titrated under each condition from 2 to 8 L/min in steps of 2 L/min. Extracorporeal CO2 elimination was normalized to a PaCO2 of 45 mmHg before the membrane lung. Results Reversal of hypercapnia was only feasible when blood flow rates above 900 mL/min were used with a membrane lung surface area of at least 0.8m2. The membrane lung with a surface of 0.4m2 allowed a maximum normalized CO2 elimination rate of 41 ± 6 mL/min with 8 L/min sweep gas flow and 900 mL blood flow/min. The increase in sweep gas flow from 2 to 8 L/min increased normalized CO2 elimination from 35 ± 5 to 41 ± 6 with 900 mL blood flow/min, whereas with lower blood flow rates, any increase was less effective, levelling out at 4 L sweep gas flow/min. The membrane lung with a surface area of 0.8m2 allowed a maximum normalized CO2 elimination rate of 101 ± 12 mL/min with increasing influence of sweep gas flow. The delta of normalized CO2 elimination increased from 4 ± 2 to 26 ± 7 mL/min with blood flow rates being increased from 300 to 1800 mL/min, respectively. Conclusions The influence of sweep gas flow on the CO2 removal capacity of ECCO2R systems depends predominantly on blood flow rate and membrane lung surface area. In this model, considerable CO2 removal occurred only with the larger membrane lung surface of 0.8m2 and when blood flow rates of ≥ 900 mL/min were used. |
| first_indexed | 2024-12-12T15:41:12Z |
| format | Article |
| id | doaj.art-1e777075321d4ca0b1e6b025cf342025 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-12-12T15:41:12Z |
| publishDate | 2019-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-1e777075321d4ca0b1e6b025cf3420252022-12-22T00:19:53ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2019-03-017111010.1186/s40635-019-0244-3Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R)Stephan Strassmann0Michaela Merten1Simone Schäfer2Jonas de Moll3Daniel Brodie4Anders Larsson5Wolfram Windisch6Christian Karagiannidis7Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDivision of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons/New York-Presbyterian HospitalHedenstierna Laboratory, Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala UniversityDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalDepartment of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University HospitalAbstract Background Veno-venous extracorporeal carbon dioxide (CO2) removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates range in clinical practice from 200 mL/min to more than 1500 mL/min, and sweep gas flow rates range from less than 1 to more than 10 L/min. The present porcine model study was aimed at determining the impact of varying sweep gas flow rates on CO2 removal under different blood flow conditions and membrane lung surface areas. Methods Two different membrane lungs, with surface areas of 0.4 and 0.8m2, were used in nine pigs with experimentally-induced hypercapnia. During each experiment, the blood flow was increased stepwise from 300 to 900 mL/min, with further increases up to 1800 mL/min with the larger membrane lung in steps of 300 mL/min. Sweep gas was titrated under each condition from 2 to 8 L/min in steps of 2 L/min. Extracorporeal CO2 elimination was normalized to a PaCO2 of 45 mmHg before the membrane lung. Results Reversal of hypercapnia was only feasible when blood flow rates above 900 mL/min were used with a membrane lung surface area of at least 0.8m2. The membrane lung with a surface of 0.4m2 allowed a maximum normalized CO2 elimination rate of 41 ± 6 mL/min with 8 L/min sweep gas flow and 900 mL blood flow/min. The increase in sweep gas flow from 2 to 8 L/min increased normalized CO2 elimination from 35 ± 5 to 41 ± 6 with 900 mL blood flow/min, whereas with lower blood flow rates, any increase was less effective, levelling out at 4 L sweep gas flow/min. The membrane lung with a surface area of 0.8m2 allowed a maximum normalized CO2 elimination rate of 101 ± 12 mL/min with increasing influence of sweep gas flow. The delta of normalized CO2 elimination increased from 4 ± 2 to 26 ± 7 mL/min with blood flow rates being increased from 300 to 1800 mL/min, respectively. Conclusions The influence of sweep gas flow on the CO2 removal capacity of ECCO2R systems depends predominantly on blood flow rate and membrane lung surface area. In this model, considerable CO2 removal occurred only with the larger membrane lung surface of 0.8m2 and when blood flow rates of ≥ 900 mL/min were used.http://link.springer.com/article/10.1186/s40635-019-0244-3ARDSExtracorporeal carbon dioxide removalCOPDECCO2RECMO |
| spellingShingle | Stephan Strassmann Michaela Merten Simone Schäfer Jonas de Moll Daniel Brodie Anders Larsson Wolfram Windisch Christian Karagiannidis Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) Intensive Care Medicine Experimental ARDS Extracorporeal carbon dioxide removal COPD ECCO2R ECMO |
| title | Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) |
| title_full | Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) |
| title_fullStr | Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) |
| title_full_unstemmed | Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) |
| title_short | Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R) |
| title_sort | impact of sweep gas flow on extracorporeal co2 removal ecco2r |
| topic | ARDS Extracorporeal carbon dioxide removal COPD ECCO2R ECMO |
| url | http://link.springer.com/article/10.1186/s40635-019-0244-3 |
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