Alberto Zanella1,2, Pietro Caironi3, Luigi Castagna2, Emanuele Rezoagli4,5,6, Domenico Salerno4, Eleonora Scotti1, Vittorio Scaravilli2, Salua A Deab7, Thomas Langer1,2, Tommaso Mauri1,2, Michele Ferrari1, Daniele Dondossola1,8, Manuela Chiodi1, Francesco Zadek1, Federico Magni9, Stefano Gatti10, Luciano Gattinoni11, Antonio M Pesenti1,2. 1. Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy. 2. Department of Anesthesia, Critical Care, and Emergency. 3. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy; Department of Oncology, University of Turin, Orbassano, Italy. 4. Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 5. Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, and Discipline of Anaesthesia, School of Medicine, National University of Ireland Galway, Galway, Ireland. 6. Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, SAOLTA University Health Group, Galway, Ireland. 7. ASST Monza-Hospital of Desio, Desio, Italy. 8. General and Liver Transplant Surgery Unit, and. 9. Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy; and. 10. Center for Preclinical Research, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 11. Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany.
Abstract
Rationale: Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH; however, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia. Objectives: To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through extracorporeal chloride removal by electrodialysis. Methods: Ten swine (six treated and four control animals) were sedated, mechanically ventilated and connected to an extracorporeal electrodialysis device capable of selectively removing chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started to restore pH.Measurements and Main Results: During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26 ± 5 mEq/L within 6 hours (final pH = 7.36 ± 0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH = 7.29 ± 0.03; P < 0.001). During metabolic acidosis, electrodialysis reduced plasma chloride concentration by 15 ± 3 mEq/L within 4 hours (final pH = 7.34 ± 0.07). No effective compensatory response occurred in control animals (final pH = 7.11 ± 0.08; P < 0.001). No complications occurred.Conclusions: We described the first in vivo application of an extracorporeal system targeted to correct severe acidemia by lowering plasma chloride concentration. Extracorporeal chloride removal by electrodialysis proved to be feasible, safe, and effective. Further studies are warranted to assess its performance in the presence of impaired respiratory and renal functions.
Rationale: Acidemia is a severe condition among critically illpatients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH; however, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia. Objectives: To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through extracorporeal chloride removal by electrodialysis. Methods: Ten swine (six treated and four control animals) were sedated, mechanically ventilated and connected to an extracorporeal electrodialysis device capable of selectively removing chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started to restore pH.Measurements and Main Results: During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26 ± 5 mEq/L within 6 hours (final pH = 7.36 ± 0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH = 7.29 ± 0.03; P < 0.001). During metabolic acidosis, electrodialysis reduced plasma chloride concentration by 15 ± 3 mEq/L within 4 hours (final pH = 7.34 ± 0.07). No effective compensatory response occurred in control animals (final pH = 7.11 ± 0.08; P < 0.001). No complications occurred.Conclusions: We described the first in vivo application of an extracorporeal system targeted to correct severe acidemia by lowering plasma chloride concentration. Extracorporeal chloride removal by electrodialysis proved to be feasible, safe, and effective. Further studies are warranted to assess its performance in the presence of impaired respiratory and renal functions.
Authors: Alain Combes; Daniel Brodie; Nadia Aissaoui; Thomas Bein; Gilles Capellier; Heidi J Dalton; Jean-Luc Diehl; Stefan Kluge; Daniel F McAuley; Matthieu Schmidt; Arthur S Slutsky; Samir Jaber Journal: Intensive Care Med Date: 2022-08-09 Impact factor: 41.787
Authors: Robinder G Khemani; Jessica T Lee; David Wu; Edward J Schenck; Margaret M Hayes; Patricia A Kritek; Gökhan M Mutlu; Hayley B Gershengorn; Rémi Coudroy Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Alberto Zanella; Thomas Langer; Pietro Caironi; Luciano Gattinoni; Antonio Pesenti Journal: Am J Respir Crit Care Med Date: 2020-09-15 Impact factor: 21.405