title: Novel CO2 removal device driven by a renal-replacement system without hemofilter. A first step experimental validation.
abstract: OBJECTIVE
  To study the technical effectiveness of a novel extracorporeal CO2 removal device in removing CO2 from blood.
  
  
  METHODS
  Prospective animal study.
  
  
  METHODS
  Five adult female healthy pigs.
  
  
  METHODS
  Hypercapnic pigs were equipped with a low-flow CO2 removal device (PrismaLung(®), Hospal(®)) integrated on a CRRT platform. The rate of CO2 elimination was examined in vivo using a hollow fiber gas exchanger under various conditions (blood flow rates: 200, 300 and 400 mL/min; sweep gas flows: 2, 5, 10 and 50 L/min; FsO2: 0.21 and 1). Statistical analysis was performed with Student t-test.
  
  
  RESULTS
  The extracorporeal device produced CO2 removal rates ranging from 35 to 75 mL/min. Efficiency was increased with higher blood and sweep gas flows: reduction of PCO2 of 40.2 ± 13.0 mmHg (relative decrease of 46%, P < 0.001) and increase in pH of 0.24 ± 0.06 (7.21 before and 7.46 after filter, P < 0.001). Animals' blood gases were significantly modified after 10 minutes of treatment: PaCO2 decreased from 81.2 to 70.0 mmHg (relative decrease of 14%, P < 0.001) and pH increased from 7.17 to 7.22 (P < 0.001). No significant changes in arterial blood oxygenation were observed when using pure oxygen (increase of PaO2 from 106 to 107 mmHg, P = 0.36), allowing the use of ambient air as sweep gas through the membrane.
  
  
  CONCLUSIONS
  A device based on a Prismaflex(®) platform was technically effective in removing CO2 from the blood, thus decreasing PaCO2 and acidosis in hypercapnic pigs.
authors.affiliation: General Intensive Care Unit, réanimation adultes et unité de soins continus, département d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: tgodet@chu-clermontferrand.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Godet
authors.affiliation: Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, Paris, France. Electronic address: alain.combes@psl.aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.affiliation: INSERM U-1088, Surgical Intensive Care Unit, Amiens University Hospital, Jules-Verne University of Picardy, Amiens, France. Electronic address: eliezogheib1@yahoo.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.affiliation: General Intensive Care Unit, réanimation adultes et unité de soins continus, département d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France; R2D2 - EA 7281, faculté de médecine, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: mjabaudon@chu-clermontferrand.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Jabaudon
authors.affiliation: General Intensive Care Unit, réanimation adultes et unité de soins continus, département d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France; R2D2 - EA 7281, faculté de médecine, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: efutier@chu-clermontferrand.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.affiliation: Department of Critical Care, Department of Medicine and Interdepartmental Division of Critical Care Medicine, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, St. Michael's Hospital, University of Toronto, 30, Bond Street, Toronto, Ontario M5B1W8, Canada. Electronic address: arthurslutsky@gmail.com.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.affiliation: General Intensive Care Unit, réanimation adultes et unité de soins continus, département d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France; R2D2 - EA 7281, faculté de médecine, université Auvergne - Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: jmconstantin@chu-clermontferrand.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
mesh_terms: D000142:Acidosis, Respiratory / Q000517:prevention & control; D000818:Animals; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood / Q000302:isolation & purification*; D005112:Extracorporeal Circulation; D005260:Female; D006339:Heart Rate; D006440:Hemofiltration; D006863:Hydrogen-Ion Concentration; D006935:Hypercapnia / Q000628:therapy; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Acute respiratory distress syndrome; Chronic obstructive pulmonary disease; Extracorporeal CO(2) removal; Hypercapnia; Ventilator-induced lung injury