PMID- 24341694
OWN - NLM
STAT- MEDLINE
DCOM- 20140804
LR  - 20131217
IS  - 1399-6576 (Electronic)
IS  - 0001-5172 (Linking)
VI  - 58
IP  - 1
DP  - 2014 Jan
TI  - Pumpless extracorporeal CO(2) removal restores normocapnia and is associated with 
      less regional perfusion in experimental acute lung injury.
PG  - 52-60
LID - 10.1111/aas.12217 [doi]
AB  - BACKGROUND: Lung protective ventilation may lead to hypoventilation with 
      subsequent hypercapnic acidosis (HA). If HA cannot be tolerated or occurs despite 
      increasing respiratory rate or buffering, extracorporeal CO2-removal using a 
      percutaneous extracorporeal lung assist (pECLA) is an option. We hypothesised 
      that compensation of HA using pECLA impairs regional perfusion. To test this 
      hypothesis we determined organ blood flows in a lung-injury model with combined 
      hypercapnic and metabolic acidosis. METHODS: After induction of lung injury using 
      hydrochloric acid (HCl) aspiration and metabolic acidosis by intravenous HCl 
      infusion in nine pigs, an arterial-venous pECLA device was inserted. In 
      randomised order, four treatments were tested: pECLA shunt (1) with and (2) 
      without HA, and clamped pECLA shunt (3) with and (4) without HA. Regional blood 
      flows were measured with the coloured microsphere technique. RESULTS: HA resulted 
      in higher perfusion in adrenal glands, spleen and parts of splanchnic area 
      (P < 0.05) compared with normocapnia. During CO2-removal with pECLA, regional 
      perfusion decreased to levels comparable with those without pECLA and 
      normocapnia. Cardiac output (CO) increased during HA without a pECLA shunt and 
      was highest during HA with a pECLA shunt compared with normocapnia. During 
      CO2-removal with pECLA, this variable decreased but stayed higher than during 
      normocapnia with clamped pECLA shunt (P < 0.05). CONCLUSION: In our lung-injury 
      model, HA was associated with increased systemic and regional blood flow in 
      several organs. pECLA provides effective CO2 removal, requiring a higher CO for 
      perfusion of the pECLA device without improvement of regional organ perfusion.
CI  - (c) 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John 
      Wiley & Sons Ltd.
FAU - Kreyer, S
AU  - Kreyer S
AD  - Department of Anesthesiology and Intensive Care Medicine, University of Bonn, 
      Bonn, Germany.
FAU - Muders, T
AU  - Muders T
FAU - Luepschen, H
AU  - Luepschen H
FAU - Kricklies, C
AU  - Kricklies C
FAU - Linden, K
AU  - Linden K
FAU - Tolba, R
AU  - Tolba R
FAU - Varelmann, D
AU  - Varelmann D
FAU - Zinserling, J
AU  - Zinserling J
FAU - Putensen, C
AU  - Putensen C
FAU - Wrigge, H
AU  - Wrigge H
LA  - eng
SI  - GENBANK/CD003844
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131107
PL  - England
TA  - Acta Anaesthesiol Scand
JT  - Acta anaesthesiologica Scandinavica
JID - 0370270
RN  - 142M471B3J (Carbon Dioxide)
SB  - IM
MH  - Acidosis/blood
MH  - Acute Lung Injury/*blood
MH  - Adrenal Glands/blood supply
MH  - Animals
MH  - Carbon Dioxide/*blood
MH  - Cardiac Output/physiology
MH  - Microspheres
MH  - Molecular Sequence Data
MH  - Positive-Pressure Respiration
MH  - Pulmonary Circulation/physiology
MH  - Regional Blood Flow
MH  - Respiration, Artificial
MH  - Splanchnic Circulation/physiology
MH  - Swine
EDAT- 2013/12/18 06:00
MHDA- 2014/08/05 06:00
CRDT- 2013/12/18 06:00
PHST- 2013/09/17 00:00 [accepted]
PHST- 2013/12/18 06:00 [entrez]
PHST- 2013/12/18 06:00 [pubmed]
PHST- 2014/08/05 06:00 [medline]
AID - 10.1111/aas.12217 [doi]
PST - ppublish
SO  - Acta Anaesthesiol Scand. 2014 Jan;58(1):52-60. doi: 10.1111/aas.12217. Epub 2013 
      Nov 7.