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Assessment of the optimal operating parameters during extracorporeal CO2 removal with the Abylcap® system

Sunny Eloot (UGent) , Harlinde Peperstraete (UGent) , Filip De Somer (UGent) and Eric Hoste (UGent)
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Abstract
Purpose: 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 (ECCO2 R) can be applied. The aim of this study was to derive optimal operating parameters for the ECCO2 R Abylcap (R) system (Bellco, Italy). Methods: We included 4 ARDS patients with a partial arterial oxygen tension over the fraction of inspired oxygen (PaO2 /FiO(2)) lower than 150 mmHg, receiving lung-protective ventilation and treated with the Abylcap (R) 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 (R) inlet and outlet for different blood flows (Q(B) : 200-300-400 mL/min) with 100% O-2 gas flow (Q(G)) of 7 L/min, and for different Q(G) (Q(G) : 0.5-1-1.5-3-6-8 L/min) with Q(B) 400 mL/min. CO2 and O-2 transfer remained constant over 5 days for a fixed Q(B). Results: We found that, for a fixed Q(G) of 7 L/min, CO2 transfer linearly and significantly increased with Q(B) (i.e. from 58 +/- 8 to 98 +/- 16 mL/min for Q(B) 200 to 400 mL/min). For a fixed Q(B) of 400 mL/min, CO2 transfer non-linearly increased with Q(G) (i.e. from 39 +/- 9 to 98 +/- 16 mL/min for Q(G) 0.5 to 8 L/min) reaching a plateau at Q(G) of 6 L/min. Conclusions: Hence, when using the Abylcap (R) ECCO2 R in the treatment of ARDS patients the O-2 flow should be at least 6 L/min while Q(B) should be set at its maximum.
Keywords
ARDS, Extracorporeal CO2 removal, Hypercapnia, Respiratory acidosis, RESPIRATORY-DISTRESS-SYNDROME, LUNG INJURY, HYDROPHILIC MEMBRANES, BERLIN DEFINITION, VENTILATION, EXPERIENCE, BLOOD

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Chicago
Eloot, Sunny, Harlinde Peperstraete, Filip De Somer, and Eric Hoste. 2017. “Assessment of the Optimal Operating Parameters During Extracorporeal CO2 Removal with the Abylcap® System.” International Journal of Artificial Organs 39 (11): 580–585.
APA
Eloot, Sunny, Peperstraete, H., De Somer, F., & Hoste, E. (2017). Assessment of the optimal operating parameters during extracorporeal CO2 removal with the Abylcap® system. INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 39(11), 580–585.
Vancouver
1.
Eloot S, Peperstraete H, De Somer F, Hoste E. Assessment of the optimal operating parameters during extracorporeal CO2 removal with the Abylcap® system. INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS. 2017;39(11):580–5.
MLA
Eloot, Sunny, Harlinde Peperstraete, Filip De Somer, et al. “Assessment of the Optimal Operating Parameters During Extracorporeal CO2 Removal with the Abylcap® System.” INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS 39.11 (2017): 580–585. Print.
@article{8506961,
  abstract     = {Purpose: 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 (ECCO2 R) can be applied. The aim of this study was to derive optimal operating parameters for the ECCO2 R Abylcap (R) system (Bellco, Italy). 
Methods: We included 4 ARDS patients with a partial arterial oxygen tension over the fraction of inspired oxygen (PaO2 /FiO(2)) lower than 150 mmHg, receiving lung-protective ventilation and treated with the Abylcap (R) 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 (R) inlet and outlet for different blood flows (Q(B) : 200-300-400 mL/min) with 100% O-2 gas flow (Q(G)) of 7 L/min, and for different Q(G) (Q(G) : 0.5-1-1.5-3-6-8 L/min) with Q(B) 400 mL/min. CO2 and O-2 transfer remained constant over 5 days for a fixed Q(B). 
Results: We found that, for a fixed Q(G) of 7 L/min, CO2 transfer linearly and significantly increased with Q(B) (i.e. from 58 +/- 8 to 98 +/- 16 mL/min for Q(B) 200 to 400 mL/min). For a fixed Q(B) of 400 mL/min, CO2 transfer non-linearly increased with Q(G) (i.e. from 39 +/- 9 to 98 +/- 16 mL/min for Q(G) 0.5 to 8 L/min) reaching a plateau at Q(G) of 6 L/min. 
Conclusions: Hence, when using the Abylcap (R) ECCO2 R in the treatment of ARDS patients the O-2 flow should be at least 6 L/min while Q(B) should be set at its maximum.},
  author       = {Eloot, Sunny and Peperstraete, Harlinde and De Somer, Filip and Hoste, Eric},
  issn         = {0391-3988},
  journal      = {INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS},
  keywords     = {ARDS,Extracorporeal CO2 removal,Hypercapnia,Respiratory acidosis,RESPIRATORY-DISTRESS-SYNDROME,LUNG INJURY,HYDROPHILIC MEMBRANES,BERLIN DEFINITION,VENTILATION,EXPERIENCE,BLOOD},
  language     = {eng},
  number       = {11},
  pages        = {580--585},
  title        = {Assessment of the optimal operating parameters during extracorporeal CO2 removal with the Abylcap® system},
  url          = {http://dx.doi.org/10.5301/ijao.5000542},
  volume       = {39},
  year         = {2017},
}

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