Vittorio Scaravilli1, Stefan Kreyer, Slava Belenkiy, Katharina Linden, Alberto Zanella, Yansong Li, Michael A Dubick, Leopoldo C Cancio, Antonio Pesenti, Andriy I Batchinsky. 1. From the Dipartimento Scienze della Salute, Università Milano-Bicocca, Monza, Italy (V.S., A.Z.); Comprehensive Intensive Care Research Task Area (V.S., S.K., S.B., K.L., Y.L., L.C.C., A.I.B.) and Damage Control Resuscitation Task Area (M.A.D.), United States Army Institute of Surgical Research, Fort Sam Houston, Texas; National Research Council, National Academies, Washington, D.C. (V.S., S.K.); Department of Anesthesiology and Intensive Care Medicine (S.K.) and Pediatric Department (K.L.), University Hospital Bonn, Bonn, Germany; and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università Degli Studi di Milano and Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy (A.P.).
Abstract
BACKGROUND: The authors studied the effects on membrane lung carbon dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal carbon dioxide removal (ECCO2R) technique enhanced by acidification (acid load carbon dioxide removal [ALCO2R]) via lactic acid. METHODS: Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung carbon dioxide extraction, total carbon dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. RESULTS: ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung carbon dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total carbon dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). CONCLUSIONS: ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.
BACKGROUND: The authors studied the effects on membrane lung carbon dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal carbon dioxide removal (ECCO2R) technique enhanced by acidification (acid load carbon dioxide removal [ALCO2R]) via lactic acid. METHODS: Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung carbon dioxide extraction, total carbon dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. RESULTS:ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung carbon dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total carbon dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). CONCLUSIONS:ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.
Authors: Leonie S Schwärzel; Anna M Jungmann; Nicole Schmoll; Frederik Seiler; Ralf M Muellenbach; Joachim Schenk; Quoc Thai Dinh; Robert Bals; Philipp M Lepper; Albert J Omlor Journal: Intensive Care Med Exp Date: 2020-09-11
Authors: Andrea Morelli; Lorenzo Del Sorbo; Antonio Pesenti; V Marco Ranieri; Eddy Fan Journal: Intensive Care Med Date: 2017-01-28 Impact factor: 17.440
Authors: Ingeborg Hospach; Jacques Goldstein; Kai Harenski; John G Laffey; Dominique Pouchoulin; Manuela Raible; Stefanie Votteler; Markus Storr Journal: Intensive Care Med Exp Date: 2020-05-13
Authors: Kaspar F Bachmann; Matthias Haenggi; Stephan M Jakob; Jukka Takala; Luciano Gattinoni; David Berger Journal: Am J Physiol Lung Cell Mol Physiol Date: 2020-04-15 Impact factor: 5.464
Authors: Yansong Li; Michael A Dubick; Zhangsheng Yang; Johnny L Barr; Brandon J Gremmer; Michael L Lucas; Corina Necsoiu; Bryan S Jordan; Andriy I Batchinsky; Leopoldo C Cancio Journal: PLoS One Date: 2020-11-17 Impact factor: 3.240
Authors: Leonie S Schwärzel; Anna M Jungmann; Nicole Schmoll; Frederik Seiler; Ralf M Muellenbach; Joachim Schenk; Quoc Thai Dinh; Robert Bals; Philipp M Lepper; Albert J Omlor Journal: Intensive Care Med Exp Date: 2020-09-11