Respiratory dialysis: Reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal
Respiratory dialysis: Reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal
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DOI：
10.1097/ccm.0b013e31820eda45
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发表时间：
2011-06-01
影响因子：
8.8
通讯作者：
Cancio, Leopoldo C.
中科院分区：
文献类型：
--
作者：
Batchinsky, Andriy I.;Jordan, Bryan S.;Cancio, Leopoldo C.
目的：机械通气对肺有害。使用肺保护策略可能会使患者管理复杂化，从而促使人们寻找更好的肺替代方法。我们研究了新型体外静脉 CO2 去除装置在维持正常碳酸化的同时减少分钟通气量的能力。设计：前瞻性动物研究。设置：政府实验动物重症监护病房。受试者：7 头镇静猪。干预措施：气管切开术、容量控制机械通气和 72 小时重症监护病房护理。将 15-F 双腔导管插入颈外静脉并连接到 Hemolung（一种体外泵驱动的静脉-静脉 CO2 去除装置）。每分钟通气量减少，并维持normocarbia (Paco(2) 35-45 mm Hg)。肝素化维持在 150-180 秒的激活凝血时间。 测量和主要结果：每分钟通气量 (L/min)、Hemolung 去除的 CO2 (mL/min)、Hemolung 血流量、O-2 消耗 (mL/min)、肺 CO2 产生 (mL/min)、Paco(2) 和血浆游离血红蛋白 (g/dL) 在基线（如果适用）、术后 2 小时测量设备插入，以及此后每 6 小时一次。装置插入后 2 小时，每分钟通气量从基线时的 5.6 L/min 减少至 2.6 L/min，并维持在 3 L/min 直至研究结束。 Hemolung 的 CO2 清除量在 72 小时内保持稳定，在血流量为 447 +/- 5 mL/min 时平均为 72 +/- 1.2 mL/min。插入后，O-2消耗量没有变化；肺部产生的二氧化碳减少了 50%，并保持在该水平 (p < .001)。随着动脉 PCO2 的升高或降低，Hemolung 去除的 CO2 也会升高或降低。血浆游离血红蛋白没有变化。结论：静脉去除 CO2 可使每分钟通气量减少 50%，同时维持正常碳酸血症，并且可能是机械通气的有效肺保护辅助手段。 （《重症监护医学》2011 年；39：1382-1387）
Objectives: Mechanical ventilation is injurious to the lung. Use of lung-protective strategies may complicate patient management, motivating a search for better lung-replacement approaches. We investigated the ability of a novel extracorporeal venovenous CO2 removal device to reduce minute ventilation while maintaining normocarbia.Design: Prospective animal study.Setting: Government laboratory animal intensive care unit.Subjects: Seven sedated swine.Interventions: Tracheostomy, volume-controlled mechanical ventilation, and 72 hrs of round-the-clock intensive care unit care. A 15-F dual-lumen catheter was inserted in the external jugular vein and connected to the Hemolung, an extracorporeal pump-driven venovenous CO2 removal device. Minute ventilation was reduced, and normocarbia (Paco(2) 35-45 mm Hg) maintained. Heparinization was maintained at an activated clotting time of 150-180 secs.Measurements and Main Results: Minute ventilation (L/min), CO2 removal by Hemolung (mL/min), Hemolung blood flow, O-2 consumption (mL/min), CO2 production by the lung (mL/min), Paco(2), and plasma-free hemoglobin (g/dL) were measured at baseline (where applicable), 2 hrs after device insertion, and every 6 hrs thereafter. Minute ventilation was reduced from 5.6 L/min at baseline to 2.6 L/min 2 hrs after device insertion and was maintained at 3 L/min until the end of the study. CO2 removal by Hemolung remained steady over 72 hrs, averaging 72 +/- 1.2 mL/min at blood flows of 447 +/- 5 mL/min. After insertion, O-2 consumption did not change; CO2 production by the lung decreased by 50% and stayed at that level (p < .001). As the arterial PCO2 rose or fell, so did CO2 removal by Hemolung. Plasma-free hemoglobin did not change.Conclusions: Venovenous CO2 removal enabled a 50% reduction in minute ventilation while maintaining normocarbia and may be an effective lung-protective adjunct to mechanical ventilation. (Crit Care Med 2011; 39:1382-1387)