DOI: 10.1097/01.ccm.0000458168.22241.90

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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671: EXTRACORPOREAL CARBON-DIOXIDE REMOVAL IS FEASIBLE USING A ZERO BICARBONATE DIALYSATE

Ayan Sen; John Kellum; William Federspiel

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Author Information: Mayo Clinic, Phoenix, AZ

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Learning Objectives: Extracorporeal carbon dioxide (CO2) removal (ECCOR) may enable lung protective ventilation (LPV) in Acute Respiratory Distress Syndrome (ARDS) by lowering minute ventilation and preventing severe respiratory acidosis due to hypercarbia. ECCOR may also avoid intubation and mechanical ventilation in primary hypercarbic respiratory failure as in acute COPD (chronic obstructive pulmonary disease). ECCOR in the form of continuous hemodialysis offers an alternative, more available, strategy compared to mechanical artificial lung technologies. The objective of this study was to assess feasibility of ECCOR using a novel zero bicarbonate dialysate solution in an in vivo murine model of hypercarbic respiratory failure.
Methods: A zero bicarbonate dialysate solution was developed using the Stewart equation and designed to control the strong ion difference rather than replacing bicarbonate for ECCOR. 5 Sprague-Dawley rats were anesthetized for the procedure using Isoflurane and Ketamine and kept hypoventilated under deep anesthesia. We cannulated the femoral artery for blood gas sampling and continuous blood pressure monitoring. We cannulated the femoral and internal jugular veins and a continuous blood flow (2ml/min)) circuit was created using a pump and an M10 dialysis filter (surface area, 0.04 m-sq; Gambro, Lyon, France) with the dialysate solution flowing counter-current to blood at 5 ml/min. Arterial blood gases were assessed serially using an Istat analyzer (Abbott, NJ). Respiratory dialysis (RD) was commenced when the PaCO2 reached around 75 mm Hg. This was stopped after an hour and blood gases were monitored subsequently for an additional hour.
Results: At baseline, the PaCO2 was 75 ± 5.4 mm Hg; 58 ± 2.1 mm Hg after one hour of RD and 88 ± 4.9 mm Hg, one hour after RD was stopped. Corresponding pH changes were: 7.19 ± 0.03 prior to RD; 7.3 ± 0.04 after one hour of RD; and 7.09 ± 0.06 one hour off RD reaching statistical significance(p<0.05).
Conclusions: Respiratory Dialysis is feasible in this small animal model of hypercarbic respiratory failure. It enables ECCOR with acceptable control of arterial blood pH.
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