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Intravascular Membrane Oxygenation and Carbon Dioxide Removal with IVOX: Can Improved Design and Permissive Hypercapnia Achieve Adequate Respiratory Support During Severe Respiratory Failure?
Author(s) -
ZWISCHENBERGER JOSEPH B.,
JR VICTOR J. CARDENAS,
TAO WEIKE,
NIRANJAN S. C.,
CLARK JOHN W.,
BIDANI AKHIL
Publication year - 1994
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1994.tb03332.x
Subject(s) - normocapnia , carbon dioxide removal , hypercapnia , medicine , anesthesia , oxygenator , pco2 , oxygenation , carbon dioxide , chemistry , acidosis , cardiopulmonary bypass , organic chemistry
The intravenacaval oxygenator and carbon dioxide removal device (IVOX) conceived by Mortensen at CardioPulmonics is a diffusion–limited device capable of removing 30% of CO 2 production of an adult at normocapnia with minimal reduction in ventilator requirements. Through mathematical modeling, an ex vivo venovenous bypass circuit to model the vena cava and animal models of severe smoke inhalation injury, the practice of permissive hypercapnia has been established to enhance CO 2 removal by IVOX. By allowing the blood PCO 2 to rise gradually, the CO 2 excretion by IVOX can be linearly increased in a 1: 1 relationship. Experimental and clinical studies have shown that CO 2 removal by IVOX increased from 30–40 ml/min at normal blood PCO 2 to 80–90 ml/min at PCO 2 of 90 mm Hg. In addition, IVOX with permissive hypercapnia allowed a significant reduction in minute ventilation and peak airway pressure. Design changes could also improve the performance of IVOX. Increased surface area and mixing with more fibers and crimping in new prototypes of IVOX significantly increased CO 2 removal and oxygen transfer. Active mixing in the blood to decrease the boundary layer resistance can further enhance gas exchange of IVOX. In conclusion, gas exchange by the current design of IVOX is limited, and improvements in design are needed for it to become a more clinically applicable device. Permissive hypercapnia can significantly enhance CO, removal by IVOX as well as significantly reduce ventilator requirements.