A CO Removal System Using Extracorporeal Lung and Renal Assist Device with an Acid and Alkaline Infusion

Overview

Journal J Artif Organs

Specialty Biomedical Engineering

Date 2019 Oct 5

PMID 31584110

Authors

Nozomi Takahashi

Taka-Aki Nakada

Toshikazu Sakai

Yu Kato

Kazuhiro Moriyama

Osamu Nishida

Shigeto Oda

Affiliations

Soon will be listed here.

Abstract

The patients with respiratory failure need high tidal volume by mechanical ventilation, which lead to the ventilator-induced lung injury. We developed an extracorporeal lung and renal assist device (ELRAD), comprising acid infusion, membrane lung, continuous hemodiafiltration and alkaline infusion. To evaluate this system, we conducted in vivo studies using experimental swine which were connected to the new system. In vivo experiments consist of four protocols; baseline = hemodiafiltration only (no O gas flow to membrane lung); membrane lung = "Baseline" plus O gas flow to membrane lung; "Acid infusion" = "Membrane lung" plus continuous acid infusion; ELRAD = "Acid infusion" plus continuous alkaline infusion. We changed the ventilatory rate of the mechanical ventilation to maintain PCO at 50-55 mmHg during the four protocols. The results showed that there was statistically no significant difference in the levels of pH, HCO, and base excess when each study protocol was initiated. The amount of CO eliminated by the membrane lung significantly increased by 1.6 times in the acid infusion protocol and the ELRAD protocol compared to the conventional membrane lung protocol. Minute ventilation in the ELRAD protocol significantly decreased by 0.5 times compared with the hemodiafiltration only protocol (P < 0.0001), the membrane lung (P = 0.0006) and acid infusion protocol (P = 0.0017), respectively. In conclusion, a developed CO removal system efficiently removed CO at low blood flow and reduced minute ventilation, while maintaining acid-base balance within the normal range.

References

Zampieri F, Mazza B . Mechanical Ventilation in Sepsis: A Reappraisal. Shock. 2016; 47(1S Suppl 1):41-46. DOI: 10.1097/SHK.0000000000000702. View

Cressoni M, Zanella A, Epp M, Corti I, Patroniti N, Kolobow T . Decreasing pulmonary ventilation through bicarbonate ultrafiltration: an experimental study. Crit Care Med. 2009; 37(9):2612-8. DOI: 10.1097/CCM.0b013e3181a5668a. View

Sklar M, Beloncle F, Katsios C, Brochard L, Friedrich J . Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med. 2015; 41(10):1752-62. DOI: 10.1007/s00134-015-3921-z. View

Nahas G, Sutin K, Fermon C, Streat S, Wiklund L, Wahlander S . Guidelines for the treatment of acidaemia with THAM. Drugs. 1998; 55(2):191-224. DOI: 10.2165/00003495-199855020-00003. View

Chastre J, Fagon J . Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002; 165(7):867-903. DOI: 10.1164/ajrccm.165.7.2105078. View

Rana S, Jenad H, Gay P, Buck C, Hubmayr R, Gajic O . Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study. Crit Care. 2006; 10(3):R79. PMC: 1550938. DOI: 10.1186/cc4923. View

Hoste E, Colpaert K, Vanholder R, Lameire N, De Waele J, Blot S . Sodium bicarbonate versus THAM in ICU patients with mild metabolic acidosis. J Nephrol. 2005; 18(3):303-7. View

Tranquilli W . Techniques of inhalation anesthesia in ruminants and swine. Vet Clin North Am Food Anim Pract. 1986; 2(3):593-619. DOI: 10.1016/s0749-0720(15)31208-1. View

Zanella A, Patroniti N, Isgro S, Albertini M, Costanzi M, Pirrone F . Blood acidification enhances carbon dioxide removal of membrane lung: an experimental study. Intensive Care Med. 2009; 35(8):1484-7. DOI: 10.1007/s00134-009-1513-5. View

10.

Fan E, Brodie D, Slutsky A . Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. JAMA. 2018; 319(7):698-710. DOI: 10.1001/jama.2017.21907. View

11.

Slutsky A, Ranieri V . Ventilator-induced lung injury. N Engl J Med. 2013; 369(22):2126-36. DOI: 10.1056/NEJMra1208707. View

12.

Zanella A, Giani M, Redaelli S, Mangili P, Scaravilli V, Ormas V . Infusion of 2.5 meq/min of Lactic Acid minimally increases CO2 production compared to an isocaloric glucose infusion in healthy anesthetized, mechanically ventilated pigs. Crit Care. 2013; 17(6):R268. PMC: 4056743. DOI: 10.1186/cc13098. View

13.

Nasimi A, Cardona J, Berthier M, Oriot D . Hydrochloric acid infusion for treatment of severe metabolic alkalosis in a neonate. Clin Pediatr (Phila). 1996; 35(5):271-2. DOI: 10.1177/000992289603500508. View

14.

Mani R, Schmidt W, Lund L, Herth F . Respiratory dialysis for avoidance of intubation in acute exacerbation of COPD. ASAIO J. 2013; 59(6):675-8. DOI: 10.1097/MAT.0000000000000004. View

15.

Wearden P, Federspiel W, Morley S, Rosenberg M, Bieniek P, Lund L . Respiratory dialysis with an active-mixing extracorporeal carbon dioxide removal system in a chronic sheep study. Intensive Care Med. 2012; 38(10):1705-11. PMC: 3447138. DOI: 10.1007/s00134-012-2651-8. View

16.

Zanella A, Castagna L, Abd El Aziz El Sayed Deab S, Scaravilli V, Ferlicca D, Magni F . Extracorporeal CO2 Removal by Respiratory Electrodialysis: An In Vitro Study. ASAIO J. 2015; 62(2):143-9. DOI: 10.1097/MAT.0000000000000316. View

17.

Kwun K, Boucherit T, Wong J, Richards Y . Treatment of metabolic alkalosis with intravenous infusion of concentrated hydrochloric acid. Am J Surg. 1983; 146(3):328-30. DOI: 10.1016/0002-9610(83)90408-7. View

18.

Brimioulle S, Vincent J, Dufaye P, Berre J, Degaute J, KAHN R . Hydrochloric acid infusion for treatment of metabolic alkalosis: effects on acid-base balance and oxygenation. Crit Care Med. 1985; 13(9):738-42. DOI: 10.1097/00003246-198509000-00009. View

19.

Kreyer S, Scaravilli V, Linden K, Belenkiy S, Necsoiu C, Li Y . Early Utilization of Extracorporeal CO2 Removal for Treatment of Acute Respiratory Distress Syndrome Due to Smoke Inhalation and Burns in Sheep. Shock. 2015; 45(1):65-72. DOI: 10.1097/SHK.0000000000000471. View

20.

Choi C, Kim Y, Lee F, Zabolotny J, Kahn B, Youn J . Lactate induces insulin resistance in skeletal muscle by suppressing glycolysis and impairing insulin signaling. Am J Physiol Endocrinol Metab. 2002; 283(2):E233-40. DOI: 10.1152/ajpendo.00557.2001. View