TY - JOUR
T1 - Carbon Dioxide Elimination during Veno-Venous Extracorporeal Membrane Oxygenation Weaning
T2 - A Pilot Study
AU - Belliato, Mirko
AU - Cremascoli, Luca
AU - Epis, Francesco
AU - Ferrari, Fiorenza
AU - Quattrone, Maria G.
AU - Malfertheiner, Maximilian V.
AU - Broman, Lars M.
AU - Aliberti, Anna
AU - Taccone, Fabio S.
AU - Iotti, Giorgio A.
AU - Lorusso, Roberto
N1 - Publisher Copyright:
© 2021 Journal of Physical Chemistry. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V′CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO. We enrolled patients with acute respiratory distress syndrome (ARDS). The V′CO2NL ratio (V′CO2NL/V′CO2TOT) value was calculated based on the distribution of CO2between the NL and the ML. Of 18 patients, 15 were successfully weaned off of V-V ECMO. In this subgroup, we observed a significant increase in the V′CO2NL ratio comparing the median values of the first and last quartiles (0.32 vs. 0.53, p = 0.0045), without observing any modifications in the ventilation parameters. An increase in the V′CO2NL ratio, independently from any change in ventilation could, despite the limitations of the study, indicate an improvement in pulmonary function and may be used as a weaning index for ECMO.
AB - Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V′CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO. We enrolled patients with acute respiratory distress syndrome (ARDS). The V′CO2NL ratio (V′CO2NL/V′CO2TOT) value was calculated based on the distribution of CO2between the NL and the ML. Of 18 patients, 15 were successfully weaned off of V-V ECMO. In this subgroup, we observed a significant increase in the V′CO2NL ratio comparing the median values of the first and last quartiles (0.32 vs. 0.53, p = 0.0045), without observing any modifications in the ventilation parameters. An increase in the V′CO2NL ratio, independently from any change in ventilation could, despite the limitations of the study, indicate an improvement in pulmonary function and may be used as a weaning index for ECMO.
KW - acute respiratory distress syndrome
KW - extracorporeal carbon dioxide removal
KW - extracorporeal membrane oxygenation weaning
KW - mechanical ventilation
KW - veno-venous extracorporeal membrane oxygenation
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U2 - 10.1097/MAT.0000000000001282
DO - 10.1097/MAT.0000000000001282
M3 - Article
C2 - 33074866
AN - SCOPUS:85107089186
SP - 700
EP - 708
JO - ASAIO Journal
JF - ASAIO Journal
SN - 0162-1432
ER -