PMID- 23603884
OWN - NLM
STAT- MEDLINE
DCOM- 20140203
LR  - 20130610
IS  - 1537-1921 (Electronic)
IS  - 0898-4921 (Linking)
VI  - 25
IP  - 3
DP  - 2013 Jul
TI  - The effect of pumpless extracorporeal CO2 removal on regional perfusion of the 
      brain in experimental acute lung injury.
PG  - 324-9
LID - 10.1097/ANA.0b013e3182905e6a [doi]
AB  - BACKGROUND: Lung-protective mechanical ventilation with low tidal volumes (V(T)) 
      is often associated with hypercapnia (HC), which may be unacceptable in patients 
      with brain injury. CO2 removal using a percutaneous extracorporeal lung assist 
      (pECLA) enables normocapnia despite low V(T), but its effects on regional 
      cerebral blood flow (rCBF) remain ambiguous. We hypothesized that reversal of HC 
      by pECLA impairs rCBF in a porcine lung injury model. METHODS: Lung injury was 
      induced in 9 anesthetized pigs by hydrochloric acid aspiration. rCBF and systemic 
      hemodynamics were measured by colored microsphere technique and 
      transpulmonary-thermodilution during a randomized sequence of 4 experimental 
      situations: pECLA shunt-on (1) with HC and (2) without HC, pECLA shunt-off (3) 
      with HC and (4) without HC. RESULTS: HC increased rCBF (P<0.05). CO2 removal with 
      pECLA resulting in normocapnia, decreased rCBF to levels comparable to those 
      without pECLA and normocapnia. HC resulted in increased cardiac output (+25.5%). 
      Cardiac output was highest during HC with pECLA shunt (+44.9%). During pECLA with 
      CO2 removal, cardiac output (+38.1%) decreased compared with pECLA without CO2 
      removal, but stayed higher than during normocapnia/no pECLA shunt (P<0.05). 
      CONCLUSIONS: In this animal model, mechanical ventilation with low V(T) was 
      associated with HC and increased rCBF. CO2 removal by pECLA restored normocapnia, 
      reduced rCBF to levels of normocapnia, but required a higher systemic blood flow 
      for the perfusion of the pECLA device. If these results could be transferred to 
      patients, extracorporeal CO2 removal might be an option for treatment of combined 
      lung and brain injury in condition of a sufficient cardiac flow reserve.
FAU - Kreyer, Stefan
AU  - Kreyer S
AD  - Department of Anesthesiology and Intensive Care Medicine, University Hospital 
      Bonn, Bonn, Germany. stefan.kreyer@uni-bonn.de
FAU - Muders, Thomas
AU  - Muders T
FAU - Luepschen, Henning
AU  - Luepschen H
FAU - Kricklies, Corinna
AU  - Kricklies C
FAU - Linden, Katharina
AU  - Linden K
FAU - Soehle, Martin
AU  - Soehle M
FAU - Zinserling, Joerg
AU  - Zinserling J
FAU - Putensen, Christian
AU  - Putensen C
FAU - Wrigge, Hermann
AU  - Wrigge H
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Neurosurg Anesthesiol
JT  - Journal of neurosurgical anesthesiology
JID - 8910749
RN  - 142M471B3J (Carbon Dioxide)
RN  - QTT17582CB (Hydrochloric Acid)
SB  - IM
MH  - Acidosis/physiopathology
MH  - Acute Lung Injury/chemically induced/*physiopathology
MH  - Animals
MH  - Blood Gas Analysis
MH  - Carbon Dioxide/*analysis
MH  - Cardiac Output/physiology
MH  - Cerebrovascular Circulation/*physiology
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Hemodynamics/physiology
MH  - Hydrochloric Acid
MH  - Hydrogen-Ion Concentration
MH  - Hypercapnia/etiology/*physiopathology
MH  - Microspheres
MH  - Respiratory Mechanics/physiology
MH  - Swine
EDAT- 2013/04/23 06:00
MHDA- 2014/02/04 06:00
CRDT- 2013/04/23 06:00
PHST- 2013/04/23 06:00 [entrez]
PHST- 2013/04/23 06:00 [pubmed]
PHST- 2014/02/04 06:00 [medline]
AID - 10.1097/ANA.0b013e3182905e6a [doi]
PST - ppublish
SO  - J Neurosurg Anesthesiol. 2013 Jul;25(3):324-9. doi: 10.1097/ANA.0b013e3182905e6a.