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CO2 and O2 removal during continuous veno-venous hemofiltration: a pilot study
Joop Jonckheer1, Herbert Spapen2, Aziz Debain3
1Intensive Care, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium. Joop.jonckheer@uzbrussel.be.
BMC Nephrology
|June 19, 2019
Summary
Continuous veno-venous hemofiltration (CVVH) effectively removes carbon dioxide (CO2) in critically ill patients. This study quantifies CO2 removal during CVVH, offering a bedside method for calculation.
Area of Science:
- Critical Care Medicine
- Nephrology
- Cardiopulmonary Physiology
Background:
- Carbon dioxide (CO2) accumulation poses challenges in critically ill patients.
- Renal replacement therapy, specifically continuous veno-venous hemofiltration (CVVH), can eliminate CO2, but its clinical relevance requires further investigation.
- Limited studies exist on CO2 removal during CVVH.
Purpose of the Study:
- To prospectively investigate carbon dioxide (CO2) and oxygen (O2) behavior at various sampling points within the CVVH circuit.
- To develop a model for calculating CO2 removal at the bedside during CVVH.
- To assess the impact of citrate on transmembrane CO2 removal.
Main Methods:
- Prospective study involving 10 patients undergoing standard CVVH with citrate anticoagulation.
- Blood gas analysis performed at multiple points within the CVVH circuit.
- Comparison of CO2 and O2 flow rates before and after replacing citrate with NaCl 0.9%.
Main Results:
- CO2 removal in the CVVH effluent (26.0 ml/min) significantly correlated with transmembrane CO2 removal (24.2 ml/min), accounting for 14% of expired CO2 in ventilated patients.
- Minimal CO2 removal occurred in the de-aeration chamber, indicating efficient clearance across the membrane filter.
- No significant differences in total CO2 (tCO2) or O2 flow (V̇O2) were observed across the CVVH circuit or with different anticoagulation solutions.
Conclusions:
- Continuous veno-venous hemofiltration (CVVH) removes a significant amount of carbon dioxide (CO2) in critically ill patients.
- CO2 removal can be quantified through a single blood gas analysis within the CVVH circuit.
- Further research is needed to determine the clinical impact of CO2 removal by CVVH.
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