Eloot Sunny, Peperstraete Harlinde, De Somer Filip, Hoste Eric
Hemodialysis, Nephrology Department, Ghent University Hospital, Ghent - Belgium.
Intensive Care, Ghent University Hospital, Ghent - Belgium.
Int J Artif Organs. 2017 Jan 13;39(11):580-585. doi: 10.5301/ijao.5000542. Epub 2017 Jan 12.
Lung protective ventilation is recommended in patients with acute respiratory distress syndrome (ARDS) needing mechanical ventilation. This can however be associated with hypercapnia and respiratory acidosis, such that extracorporeal CO2 removal (ECCO2R) can be applied. The aim of this study was to derive optimal operating parameters for the ECCO2R Abylcap® system (Bellco, Italy).
We included 4 ARDS patients with a partial arterial oxygen tension over the fraction of inspired oxygen (PaO2/FiO2) lower than 150 mmHg, receiving lung-protective ventilation and treated with the Abylcap® via a double lumen 13.5-Fr dialysis catheter in the femoral vein. Every 24 hours during 5 consecutive days, blood was sampled at the Abylcap® inlet and outlet for different blood flows (QB:200-300-400 mL/min) with 100% O2 gas flow (QG) of 7 L/min, and for different QG (QG: 0.5-1-1.5-3-6-8 L/min) with QB400 mL/min. CO2 and O2 transfer remained constant over 5 days for a fixed QB.
We found that, for a fixed QG of 7 L/min, CO2 transfer linearly and significantly increased with QB (i.e. from 58 ± 8 to 98 ± 16 mL/min for QB 200 to 400 mL/min). For a fixed QB of 400 mL/min, CO2 transfer non-linearly increased with QG (i.e. from 39 ± 9 to 98 ± 16 mL/min for QG 0.5 to 8 L/min) reaching a plateau at QG of 6 L/min.
Hence, when using the Abylcap® ECCO2R in the treatment of ARDS patients the O2 flow should be at least 6 L/min while QB should be set at its maximum.
对于需要机械通气的急性呼吸窘迫综合征（ARDS）患者，推荐采用肺保护性通气。然而，这可能会伴有高碳酸血症和呼吸性酸中毒，因此可应用体外二氧化碳清除（ECCO2R）。本研究的目的是得出ECCO2R Abylcap®系统（意大利贝乐科公司）的最佳操作参数。
我们纳入了4例动脉血氧分压与吸入氧分数之比（PaO2/FiO2）低于150 mmHg的ARDS患者，这些患者接受肺保护性通气，并通过股静脉内的双腔13.5-Fr透析导管使用Abylcap®进行治疗。在连续5天的时间里，每天24小时，在Abylcap®的入口和出口采集血液样本，针对不同的血流量（QB：200 - 300 - 400 mL/分钟），氧气流量（QG）为7 L/分钟；以及针对不同的QG（QG：0.5 - 1 - 1.5 - 3 - 6 - 8 L/分钟），QB为400 mL/分钟。对于固定的QB，二氧化碳和氧气的转移在5天内保持恒定。
我们发现，对于固定的QG为7 L/分钟，二氧化碳转移量随QB呈线性且显著增加（即QB从200 mL/分钟增加到400 mL/分钟时，从58±8增加到98±16 mL/分钟）。对于固定的QB为400 mL/分钟，二氧化碳转移量随QG呈非线性增加（即QG从0.5 L/分钟增加到8 L/分钟时，从39±9增加到98±16 mL/分钟），在QG为6 L/分钟时达到平台期。
因此，在使用Abylcap® ECCO2R治疗ARDS患者时，氧气流量应至少为6 L/分钟，而QB应设置为最大值。
