Dataset Information

Low-flow CO? removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements.

ABSTRACT:

Introduction

Lung-protective ventilation in patients with ARDS and multiorgan failure, including renal failure, is often paralleled with a combined respiratory and metabolic acidosis. We assessed the effectiveness of a hollow-fiber gas exchanger integrated into a conventional renal-replacement circuit on CO? removal, acidosis, and hemodynamics.

Methods

In ten ventilated critically ill patients with ARDS and AKI undergoing renal- and respiratory-replacement therapy, effects of low-flow CO? removal on respiratory acidosis compensation were tested by using a hollow-fiber gas exchanger added to the renal-replacement circuit. This was an observational study on safety, CO?-removal capacity, effects on pH, ventilator settings, and hemodynamics.

Results

CO? elimination in the low-flow circuit was safe and was well tolerated by all patients. After 4 hours of treatment, a mean reduction of 17.3 mm Hg (-28.1%) pCO? was observed, in line with an increase in pH. In hemodynamically instable patients, low-flow CO? elimination was paralleled by hemodynamic improvement, with an average reduction of vasopressors of 65% in five of six catecholamine-dependent patients during the first 24 hours.

Conclusions

Because no further catheters are needed, besides those for renal replacement, the implementation of a hollow-fiber gas exchanger in a renal circuit could be an attractive therapeutic tool with only a little additional trauma for patients with mild to moderate ARDS undergoing invasive ventilation with concomitant respiratory acidosis, as long as no severe oxygenation defects indicate ECMO therapy.

SUBMITTER: Forster C

PROVIDER: S-EPMC4056563 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Low-flow CO₂ removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements.

Forster Christian C Schriewer Jens J John Stefan S Eckardt Kai-Uwe KU Willam Carsten C

Critical care (London, England) 20130724 4

<h4>Introduction</h4>Lung-protective ventilation in patients with ARDS and multiorgan failure, including renal failure, is often paralleled with a combined respiratory and metabolic acidosis. We assessed the effectiveness of a hollow-fiber gas exchanger integrated into a conventional renal-replacement circuit on CO₂ removal, acidosis, and hemodynamics.<h4>Methods</h4>In ten ventilated critically ill patients with ARDS and AKI undergoing renal- and respiratory-replacement therapy, effects of low- ...[more]

PMID: 23883472

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