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In vitro characterization of PrismaLung+: a novel ECCO2R device
Intensive Care Medicine Experimental Pub Date : 2020-05-13 , DOI: 10.1186/s40635-020-00301-7
Ingeborg Hospach 1 , Jacques Goldstein 2 , Kai Harenski 3 , John G Laffey 4 , Dominique Pouchoulin 5 , Manuela Raible 1 , Stefanie Votteler 1 , Markus Storr 1
Affiliation  

Invasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury. Advances in extracorporeal CO2 removal (ECCO2R) technologies may facilitate more protective lung ventilation in acute respiratory distress syndrome, and enable earlier weaning and/or avoid invasive mechanical ventilation entirely in chronic obstructive pulmonary disease exacerbations. We evaluated the in vitro CO2 removal capacity of the novel PrismaLung+ ECCO2R device compared with two existing gas exchangers. The in vitro CO2 removal capacity of the PrismaLung+ (surface area 0.8 m2, Baxter) was compared with the PrismaLung (surface area 0.35 m2, Baxter) and A.L.ONE (surface area 1.35 m2, Eurosets) devices, using a closed-loop bovine blood–perfused extracorporeal circuit. The efficacy of each device was measured at varying pCO2 inlet (pinCO2) levels (45, 60, and 80 mmHg) and blood flow rates (QB) of 200–450 mL/min; the PrismaLung+ and A.L.ONE devices were also tested at a QB of 600 mL/min. The amount of CO2 removed by each device was assessed by measurement of the CO2 infused to maintain circuit equilibrium (CO2 infusion method) and compared with measured CO2 concentrations in the inlet and outlet of the CO2 removal device (blood gas analysis method). The PrismaLung+ device performed similarly to the A.L.ONE device, with both devices demonstrating CO2 removal rates ~ 50% greater than the PrismaLung device. CO2 removal rates were 73 ± 4.0, 44 ± 2.5, and 72 ± 1.9 mL/min, for PrismaLung+, PrismaLung, and A.L.ONE, respectively, at QB 300 mL/min and pinCO2 45 mmHg. A Bland–Altman plot demonstrated that the CO2 infusion method was comparable to the blood gas analysis method for calculating CO2 removal. The resistance to blood flow across the test device, as measured by pressure drop, varied as a function of blood flow rate, and was greatest for PrismaLung and lowest for the A.L.ONE device. The newly developed PrismaLung+ performed more effectively than PrismaLung, with performance of CO2 removal comparable to A.L.ONE at the flow rates tested, despite the smaller membrane surface area of PrismaLung+ versus A.L.ONE. Clinical testing of PrismaLung+ is warranted to further characterize its performance.

中文翻译:

PrismaLung+ 的体外表征:一种新型 ECCO2R 装置

在严重急性呼吸衰竭的情况下,有创机械通气可以挽救生命,但会导致通气引起的肺损伤。体外 CO2 去除 (ECCO2R) 技术的进步可能有助于在急性呼吸窘迫综合征中进行更具保护性的肺通气,并在慢性阻塞性肺疾病恶化中实现更早的撤机和/或完全避免有创机械通气。我们评估了新型 PrismaLung+ ECCO2R 设备与两种现有气体交换器的体外 CO2 去除能力。PrismaLung+(表面积 0.8 m2,Baxter)的体外 CO2 去除能力与 PrismaLung(表面积 0.35 m2,Baxter)和 ALONE(表面积 1.35 m2,Eurosets)设备进行了比较,使用闭环牛血–灌注体外回路。在不同的 pCO2 入口 (pinCO2) 水平(45、60 和 80 mmHg)和 200–450 mL/min 的血流速率 (QB) 下测量每个设备的功效;PrismaLung+ 和 ALONE 设备也在 600 mL/min 的 QB 下进行了测试。通过测量为维持回路平衡而注入的 CO2(CO2 注入方法)并与测量的 CO2 去除设备入口和出口的 CO2 浓度进行比较(血气分析方法)来评估每个设备去除的 CO2 量。PrismaLung+ 设备的性能与 ALONE 设备相似,两种设备的 CO2 去除率都比 PrismaLung 设备高约 50%。对于 PrismaLung+、PrismaLung 和 ALONE,在 QB 300 mL/min 和 pinCO2 45 mmHg 时,CO2 去除率分别为 73 ± 4.0、44 ± 2.5 和 72 ± 1.9 mL/min。Bland-Altman 图表明 CO2 输注方法与血气分析方法在计算 CO2 去除率方面具有可比性。通过压降测量的血液流经测试装置的阻力随血流速率而变化,PrismaLung 的阻力最大,而 ALONE 装置的阻力最低。新开发的 PrismaLung+ 的性能比 PrismaLung 更有效,尽管与 ALONE 相比,PrismaLung+ 的膜表面积较小,但在测试的流速下,其 CO2 去除性能与 ALONE 相当。有必要对 PrismaLung+ 进行临床测试以进一步表征其性能。PrismaLung 最大,ALONE 设备最低。新开发的 PrismaLung+ 比 PrismaLung 更有效,尽管与 ALONE 相比,PrismaLung+ 的膜表面积较小,但在测试的流速下,其 CO2 去除性能与 ALONE 相当。有必要对 PrismaLung+ 进行临床测试以进一步表征其性能。PrismaLung 最大,ALONE 设备最低。新开发的 PrismaLung+ 的性能比 PrismaLung 更有效,尽管与 ALONE 相比,PrismaLung+ 的膜表面积较小,但在测试的流速下,其 CO2 去除性能与 ALONE 相当。有必要对 PrismaLung+ 进行临床测试以进一步表征其性能。
更新日期:2020-05-13
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