Source: Annual Congress 2010 - Acute respiratory failure
Disease area: Respiratory critical care

Abstract

Extracorporeal CO2 removal is an effective adjunctive measure to limit ventilator induced–lung injury in ARDS patients, but it carries significant side effects due to the high extracorporeal blood flow required. Recently, we showed that lactic acid infusion (1 mEq/100 ml of extracorporeal blood flow) before a membrane lung (ML) safely enhances CO2 removal. Here we studied, in 4 anesthetized pigs connected to an extracorporeal circuit comprising a ML (blood flow of 250 ml/min), the mid-term safety and efficacy of lactic acid infusion (2.5 mEq/min) in improving extracorporeal CO2 removal. Hemodynamics and blood gasses were measured before initiation of ECMO (baseline) and at subsequent intervals for 18 h. CO2 removal increased significantly at 1h of lactic acid infusion vs baseline, and the rise was persistent, from 106.61±36.27 (baseline) to 142.50±44.58 ml/min (18h). Concomitantly with CO2 removal, alveolar ventilation was decreased. Serum lactate (baseline 1.5±0.4 mEq/l) reached a peak of 4.8±1.2 mEq/l after 1h of acid infusion, then decreased progressively. pH decreased significantly at 1 and 3-h vs baseline, while it came back near baseline values from 6h onward. PaCO2 increased lightly at 1h, then decreased progressively, but not significantly. MAP did not vary and MPAP decreased significantly, although it remained within the physiological range. Histology of the lungs and hearts revealed no pathological findings. In conclusion, mid-term blood acidification with infusion of 2.5 mEq/min of lactic acid is effective and safe to enhance the CO2 removal capacity of the membrane lung.

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F. Pirrone, A. Zanella, S. Isgrò, N. Patroniti, M. Albertini, M. Costanzi, S. Mazzola, I. Tessaro, A. Pesenti (Milan, Monza, Italy). Mid-term study of acid infusion as a potential strategy for less invasive extracorporeal CO2 removal. Eur Respir J 2010; 36: Suppl. 54, 2288

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