TY - JOUR
T1 - Alkaline liquid ventilation of the membrane lung for extracorporeal carbon dioxide removal (Ecco2r)
T2 - In vitro study
AU - Vivona, Luigi
AU - Battistin, Michele
AU - Carlesso, Eleonora
AU - Langer, Thomas
AU - Valsecchi, Carlo
AU - Colombo, Sebastiano Maria
AU - Todaro, Serena
AU - Gatti, Stefano
AU - Florio, Gaetano
AU - Pesenti, Antonio
AU - Grasselli, Giacomo
AU - Zanella, Alberto
N1 - Funding Information:
Funding: This study was funded by the project “Optimization of extracorporeal carbon dioxide removal through blood acidification: development of new technologies” cod. GR‐2013‐02356711.
Funding Information:
Conflicts of Interest: Grasselli reported personal fees and nonfinancial support from Getinge and from Biotest, personal fees from Thermofisher, grants and personal fees from Fisher&Paykel, and personal fees from Draeger Medical outside the submitted work. Pesenti reported personal fees from Maquet, from Novalung/Xenios, from Baxter, and from Boehringer Ingelheim outside the submitted work. Zanella and Pesenti are inventors to patents licensed to Fresenius. The authors certify that they have no affiliations with, or involvement in any organization or entity with any financial or non‐financial interest in the subject matter discussed in this manuscript.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021
Y1 - 2021
N2 - Extracorporeal carbon dioxide removal (ECCO2R) is a promising strategy to manage acute respiratory failure. We hypothesized that ECCO2R could be enhanced by ventilating the membrane lung with a sodium hydroxide (NaOH) solution with high CO2 absorbing capacity. A computed mathematical model was implemented to assess NaOH–CO2 interactions. Subsequently, we compared NaOH infusion, named “alkaline liquid ventilation”, to conventional oxygen sweeping flows. We built an extracorporeal circuit with two polypropylene membrane lungs, one to remove CO2 and the other to maintain a constant PCO2 (60 ± 2 mmHg). The circuit was primed with swine blood. Blood flow was 500 mL × min−1. After testing the safety and feasibility of increasing concentrations of aqueous NaOH (up to 100 mmol × L−1), the CO2 removal capacity of sweeping oxygen was compared to that of 100 mmol × L−1 NaOH. We performed six experiments to randomly test four sweep flows (100, 250, 500, 1000 mL × min−1) for each fluid plus 10 L × min−1 oxygen. Alkaline liquid ventilation proved to be feasible and safe. No damages or hemolysis were detected. NaOH showed higher CO2 removal capacity compared to oxygen for flows up to 1 L × min−1. However, the highest CO2 extraction power exerted by NaOH was comparable to that of 10 L × min−1 oxygen. Further studies with dedicated devices are required to exploit potential clinical applications of alkaline liquid ventilation.
AB - Extracorporeal carbon dioxide removal (ECCO2R) is a promising strategy to manage acute respiratory failure. We hypothesized that ECCO2R could be enhanced by ventilating the membrane lung with a sodium hydroxide (NaOH) solution with high CO2 absorbing capacity. A computed mathematical model was implemented to assess NaOH–CO2 interactions. Subsequently, we compared NaOH infusion, named “alkaline liquid ventilation”, to conventional oxygen sweeping flows. We built an extracorporeal circuit with two polypropylene membrane lungs, one to remove CO2 and the other to maintain a constant PCO2 (60 ± 2 mmHg). The circuit was primed with swine blood. Blood flow was 500 mL × min−1. After testing the safety and feasibility of increasing concentrations of aqueous NaOH (up to 100 mmol × L−1), the CO2 removal capacity of sweeping oxygen was compared to that of 100 mmol × L−1 NaOH. We performed six experiments to randomly test four sweep flows (100, 250, 500, 1000 mL × min−1) for each fluid plus 10 L × min−1 oxygen. Alkaline liquid ventilation proved to be feasible and safe. No damages or hemolysis were detected. NaOH showed higher CO2 removal capacity compared to oxygen for flows up to 1 L × min−1. However, the highest CO2 extraction power exerted by NaOH was comparable to that of 10 L × min−1 oxygen. Further studies with dedicated devices are required to exploit potential clinical applications of alkaline liquid ventilation.
KW - Extracorporeal CO2 removal
KW - Liquid ventilation
KW - Membrane lung
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U2 - 10.3390/membranes11070464
DO - 10.3390/membranes11070464
M3 - Article
AN - SCOPUS:85109073409
VL - 11
JO - Membranes
JF - Membranes
SN - 2077-0375
IS - 7
M1 - 464
ER -