Total extracorporeal arteriovenous carbon dioxide removal in acute respiratory failure: a phase I clinical study
Total extracorporeal arteriovenous carbon dioxide removal in acute respiratory failure: a phase I clinical study
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DOI：
10.1007/s001340100993
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发表时间：
2001-08-01
影响因子：
38.9
通讯作者：
Bidani, A
中科院分区：
文献类型：
--
作者：
Conrad, SA;Zwischenberger, JB;Bidani, A
目的：评价无泵体外动静脉动静脉二氧化碳清除(AVCO(2)R)在急性呼吸衰竭和高二氧化碳血症患者中的安全性和有效性。设计：在两所大学医院的重症监护病房中，受试者接受AVCO(2)R支持长达72h的组内I相时间序列试验。患者：8例急性高二氧化碳呼吸衰竭或低氧呼吸衰竭患者合并允许性高二氧化碳。干预：通过经皮股动脉和股静脉插管实现体外二氧化碳清除，并使用商用膜气体交换装置进行简单的体外循环二氧化碳交换。测量和结果：血流动力学测量和结果。在开始应用AVCO(2)R前及随后的72h，分别进行血气分析、呼吸机设置和实验室检查，PaCO2从90.8+/-7.5 mm Hg1和2 h分别降至52.3+/-4.3和51.8+/-3.1 mm Hg。尽管每分钟通气量从基线的6.92+/-1.64 L/分钟下降到1小时和2小时的4.22+/-0.46和3.00+/-0.53 L/分钟，但这一下降仍然发生。在1小时和2小时从7.19+/-0.06增加到7.35+/-0.07和7.37+/-0.05。这些改善在AVCO2-R的整个支持期间持续存在。四名受试者进行了呼吸暂停试验，在试验中，AVCO(2)R在窒息氧合过程中提供总的二氧化碳清除，导致稳定的PaCO2值从57至85毫米汞柱。结论：无泵体外动静脉CO(2)R能在维持轻、中度高碳酸血症的同时，在急性呼吸衰竭时提供完全的体外二氧化碳清除。AVCO(2)R与机械通风和允许性高碳酸血症结合使用，可使动脉血二氧化碳分压和pH正常化，并显著降低机械通气量。
Objective: To evaluate the safety and efficacy of pumpless extracorporeal arteriovenous carbon dioxide removal (AVCO(2)R) in subjects with acute respiratory failure and hypercapnia.Design: A phase I within-group time series trial in which subjects underwent up to 72 h of support with AVCO(2)R in intensive care units of two university hospitals.Patients: Eight patients with acute hypercapnic respiratory failure or hypoxemic respiratory failure managed with permissive hypercapnia.Interventions: Extracorporeal CO2 removal was achieved through percutaneous cannulation of the femoral artery and vein, and a simple extracorporeal circuit using a commercially available membrane gas exchange device for carbon dioxide exchange.Measurements and results: Measurements of hemodynamics. blood gases, ventilatory settings, and laboratory values were made before initiation of AVCO(2)R, and at subsequent intervals for 72 h. PaCO2 decreased significantly from 90.8 +/- 7.5 mmHg to 52.3 +/- 4.3 and 51.8 +/- 3.1 mmHg at 1 and 2 h, respectively. This decrease occurred despite a decrease in minute ventilation from a baseline of 6.92 +/- 1.64 l/min to 4.22 +/- .46 and 3.00 +/- .53 l/min at 1 and 2 h. There was a normalization of pH. with an increase from 7.19 +/- .06 to 7.35 +/- .07 and 7.37 +/- .05 at 1 and 2 h. These improvements persisted during the full period of support with AVCO2-R. Four subjects underwent apnea trials in which AVCO(2)R provided total carbon dioxide removal during apneic oxygenation, resulting in steady-state PaCO2 values from 57 to 85 mmHg. Hemodynamics were not significantly altered with the institution of AVCO(2)R. There were no major complications attributed to the procedure.Conclusion: Pumpless extracorporeal AVCO(2)R is capable of providing complete extracorporeal removal of carbon dioxide during acute respiratory failure, while maintaining mild to moderate hypercapnia. Applied in conjunction with mechanical ventilation and permissive hypercapnia, AVCO(2)R resulted in normalization of arterial PCO2 and pH and permitted significant reductions in the level of mechanical ventilation.