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Query: UMLS:C0020440 (
hypercapnia
)
7,939
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Extracorporeal carbon dioxide (CO
2
) removal (ECCO
2
R) facilitates the use of low tidal volumes during protective or ultraprotective mechanical ventilation when managing patients with acute respiratory distress syndrome (ARDS); however, the rate of ECCO
2
R required to avoid
hypercapnia
remains unclear. We calculated ECCO
2
R rate requirements to maintain arterial partial pressure of CO
2
(PaCO
2
) at clinically desirable levels in mechanically ventilated ARDS patients using a six-compartment mathematical model of CO
2
and oxygen (O
2
) biochemistry and whole-body transport with the inclusion of an ECCO
2
R device for extracorporeal veno-venous removal of CO
2
. The model assumes steady state conditions. Model compartments were lung capillary blood, arterial blood, venous blood, post-ECCO
2
R venous blood, interstitial fluid and tissue cells, with CO
2
and O
2
distribution within each compartment; biochemistry included equilibrium among bicarbonate and non-bicarbonate buffers and CO
2
and O
2
binding to hemoglobin to elucidate Bohr and Haldane effects. O
2
consumption and CO
2
production rates were assumed proportional to predicted body weight (PBW) and adjusted to achieve reported arterial partial pressure of O
2
and a PaCO
2
level of 46 mmHg at a tidal volume of 7.6 mL/kg PBW in the absence of an ECCO
2
R device based on average data from
LUNG
SAFE. Model calculations showed that ECCO
2
R rates required to achieve mild permissive
hypercapnia
(PaCO
2
of 46 mmHg) at a ventilation frequency or respiratory rate of 20.8/min during mechanical ventilation increased when tidal volumes decreased from 7.6 to 3 mL/kg PBW. Higher ECCO2R rates were required to achieve normocapnia (PaCO2 of 40 mmHg). Model calculations also showed that required ECCO2R rates were lower when ventilation frequencies were increased from 20.8/min to 26/min. The current mathematical model predicts that ECCO2R rates resulting in clinically desirable PaCO2 levels at tidal volumes of 5-6 mL/kg PBW can likely be achieved in mechanically ventilated ARDS patients with current technologies; use of ultraprotective tidal volumes (3-4 mL/kg PBW) may be challenging unless high mechanical ventilation frequencies are used.
...
PMID:Extracorporeal carbon dioxide removal requirements for ultraprotective mechanical ventilation: Mathematical model predictions. 3176 43
