IVOX with Gradual Permissive Hypercapnia: A New Management Technique for Respiratory Failure

Joseph B. Zwischenberger, Thuan T. Nguyen, Weike Tao, Phillip E. Bush, Charles S. Cox, Daniel L. Traber, David Herndon, Akhil Bidani

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

IVOX (intravenous oxygenator and CO2 removal device) augments venous gas exchange in patients with severe respiratory failure. Controlled hypoventilation with permissive hypercapnia reduces airway pressures during mechanical ventilation and augments CO2 exchange through the IVOX. To quantify the additive effects of gradual permissive hypercapnia and IVOX on gas exchange and reduction of airway pressures, 13 adult sheep underwent tracheostomy and severe smoke inhalation injury. Seven were mechanically ventilated alone (control), and six had mechanical ventilation, systemic anticoagulation, and implantation of IVOX (size 7 with 0.21-m2 surface area) (IVOX group). Both groups were anesthetized and paralyzed for 24 hr. In the IVOX group, minute ventilation was decreased in a stepwise fashion to produce a gradual increase in PaCO2, from 30 to 95 mm Hg, over 12 hr, and then sustained for an additional 12 hr. Sodium bicarbonate was given intravenously as necessary to keep arterial pH above 7.25. There were no significant differences in mean arterial pressure, cardiac output, or pulmonary artery pressure between the two groups. In the IVOX/permissive hypercapnia group, IVOX CO2 removal increased as a linear function of PaCO2 (y = 0.87x + 8.99, R2 = 0.80). IVOX CO2 removal was only 40 ml/min at normocapnia (40 mm Hg) but increased to 91 ml/min when PaCO2 was 95 mm Hg. Both peak inspiratory pressure and minute ventilation of the IVOX/permissive hypercapnia group were significantly lower than the control group, 30 ± 4 mm Hg vs 51 ± 3 mm Hg and 3.9 ± 0.3 liters vs 8.4 ± 0.5 liters (P < 0.05) respectively. CO2 removal by IVOX can be substantially augmented under conditions of permissive hypercapnia, reducing the ventilatory requirements in an ovine model of acute smoke inhalation injury.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalJournal of Surgical Research
Volume57
Issue number1
DOIs
StatePublished - Jul 1994

Fingerprint

Hypercapnia
Respiratory Insufficiency
Smoke Inhalation Injury
Pressure
Artificial Respiration
Ventilation
Sheep
Gases
Device Removal
Oxygenators
Hypoventilation
Sodium Bicarbonate
Tracheostomy
Cardiac Output
Pulmonary Artery
Arterial Pressure
Control Groups

ASJC Scopus subject areas

  • Surgery

Cite this

Zwischenberger, J. B., Nguyen, T. T., Tao, W., Bush, P. E., Cox, C. S., Traber, D. L., ... Bidani, A. (1994). IVOX with Gradual Permissive Hypercapnia: A New Management Technique for Respiratory Failure. Journal of Surgical Research, 57(1), 99-105. https://doi.org/10.1006/jsre.1994.1117

IVOX with Gradual Permissive Hypercapnia : A New Management Technique for Respiratory Failure. / Zwischenberger, Joseph B.; Nguyen, Thuan T.; Tao, Weike; Bush, Phillip E.; Cox, Charles S.; Traber, Daniel L.; Herndon, David; Bidani, Akhil.

In: Journal of Surgical Research, Vol. 57, No. 1, 07.1994, p. 99-105.

Research output: Contribution to journalArticle

Zwischenberger, JB, Nguyen, TT, Tao, W, Bush, PE, Cox, CS, Traber, DL, Herndon, D & Bidani, A 1994, 'IVOX with Gradual Permissive Hypercapnia: A New Management Technique for Respiratory Failure', Journal of Surgical Research, vol. 57, no. 1, pp. 99-105. https://doi.org/10.1006/jsre.1994.1117
Zwischenberger, Joseph B. ; Nguyen, Thuan T. ; Tao, Weike ; Bush, Phillip E. ; Cox, Charles S. ; Traber, Daniel L. ; Herndon, David ; Bidani, Akhil. / IVOX with Gradual Permissive Hypercapnia : A New Management Technique for Respiratory Failure. In: Journal of Surgical Research. 1994 ; Vol. 57, No. 1. pp. 99-105.
@article{ebc17033dc3940ca948146f17691aa1f,
title = "IVOX with Gradual Permissive Hypercapnia: A New Management Technique for Respiratory Failure",
abstract = "IVOX (intravenous oxygenator and CO2 removal device) augments venous gas exchange in patients with severe respiratory failure. Controlled hypoventilation with permissive hypercapnia reduces airway pressures during mechanical ventilation and augments CO2 exchange through the IVOX. To quantify the additive effects of gradual permissive hypercapnia and IVOX on gas exchange and reduction of airway pressures, 13 adult sheep underwent tracheostomy and severe smoke inhalation injury. Seven were mechanically ventilated alone (control), and six had mechanical ventilation, systemic anticoagulation, and implantation of IVOX (size 7 with 0.21-m2 surface area) (IVOX group). Both groups were anesthetized and paralyzed for 24 hr. In the IVOX group, minute ventilation was decreased in a stepwise fashion to produce a gradual increase in PaCO2, from 30 to 95 mm Hg, over 12 hr, and then sustained for an additional 12 hr. Sodium bicarbonate was given intravenously as necessary to keep arterial pH above 7.25. There were no significant differences in mean arterial pressure, cardiac output, or pulmonary artery pressure between the two groups. In the IVOX/permissive hypercapnia group, IVOX CO2 removal increased as a linear function of PaCO2 (y = 0.87x + 8.99, R2 = 0.80). IVOX CO2 removal was only 40 ml/min at normocapnia (40 mm Hg) but increased to 91 ml/min when PaCO2 was 95 mm Hg. Both peak inspiratory pressure and minute ventilation of the IVOX/permissive hypercapnia group were significantly lower than the control group, 30 ± 4 mm Hg vs 51 ± 3 mm Hg and 3.9 ± 0.3 liters vs 8.4 ± 0.5 liters (P < 0.05) respectively. CO2 removal by IVOX can be substantially augmented under conditions of permissive hypercapnia, reducing the ventilatory requirements in an ovine model of acute smoke inhalation injury.",
author = "Zwischenberger, {Joseph B.} and Nguyen, {Thuan T.} and Weike Tao and Bush, {Phillip E.} and Cox, {Charles S.} and Traber, {Daniel L.} and David Herndon and Akhil Bidani",
year = "1994",
month = "7",
doi = "10.1006/jsre.1994.1117",
language = "English (US)",
volume = "57",
pages = "99--105",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - IVOX with Gradual Permissive Hypercapnia

T2 - A New Management Technique for Respiratory Failure

AU - Zwischenberger, Joseph B.

AU - Nguyen, Thuan T.

AU - Tao, Weike

AU - Bush, Phillip E.

AU - Cox, Charles S.

AU - Traber, Daniel L.

AU - Herndon, David

AU - Bidani, Akhil

PY - 1994/7

Y1 - 1994/7

N2 - IVOX (intravenous oxygenator and CO2 removal device) augments venous gas exchange in patients with severe respiratory failure. Controlled hypoventilation with permissive hypercapnia reduces airway pressures during mechanical ventilation and augments CO2 exchange through the IVOX. To quantify the additive effects of gradual permissive hypercapnia and IVOX on gas exchange and reduction of airway pressures, 13 adult sheep underwent tracheostomy and severe smoke inhalation injury. Seven were mechanically ventilated alone (control), and six had mechanical ventilation, systemic anticoagulation, and implantation of IVOX (size 7 with 0.21-m2 surface area) (IVOX group). Both groups were anesthetized and paralyzed for 24 hr. In the IVOX group, minute ventilation was decreased in a stepwise fashion to produce a gradual increase in PaCO2, from 30 to 95 mm Hg, over 12 hr, and then sustained for an additional 12 hr. Sodium bicarbonate was given intravenously as necessary to keep arterial pH above 7.25. There were no significant differences in mean arterial pressure, cardiac output, or pulmonary artery pressure between the two groups. In the IVOX/permissive hypercapnia group, IVOX CO2 removal increased as a linear function of PaCO2 (y = 0.87x + 8.99, R2 = 0.80). IVOX CO2 removal was only 40 ml/min at normocapnia (40 mm Hg) but increased to 91 ml/min when PaCO2 was 95 mm Hg. Both peak inspiratory pressure and minute ventilation of the IVOX/permissive hypercapnia group were significantly lower than the control group, 30 ± 4 mm Hg vs 51 ± 3 mm Hg and 3.9 ± 0.3 liters vs 8.4 ± 0.5 liters (P < 0.05) respectively. CO2 removal by IVOX can be substantially augmented under conditions of permissive hypercapnia, reducing the ventilatory requirements in an ovine model of acute smoke inhalation injury.

AB - IVOX (intravenous oxygenator and CO2 removal device) augments venous gas exchange in patients with severe respiratory failure. Controlled hypoventilation with permissive hypercapnia reduces airway pressures during mechanical ventilation and augments CO2 exchange through the IVOX. To quantify the additive effects of gradual permissive hypercapnia and IVOX on gas exchange and reduction of airway pressures, 13 adult sheep underwent tracheostomy and severe smoke inhalation injury. Seven were mechanically ventilated alone (control), and six had mechanical ventilation, systemic anticoagulation, and implantation of IVOX (size 7 with 0.21-m2 surface area) (IVOX group). Both groups were anesthetized and paralyzed for 24 hr. In the IVOX group, minute ventilation was decreased in a stepwise fashion to produce a gradual increase in PaCO2, from 30 to 95 mm Hg, over 12 hr, and then sustained for an additional 12 hr. Sodium bicarbonate was given intravenously as necessary to keep arterial pH above 7.25. There were no significant differences in mean arterial pressure, cardiac output, or pulmonary artery pressure between the two groups. In the IVOX/permissive hypercapnia group, IVOX CO2 removal increased as a linear function of PaCO2 (y = 0.87x + 8.99, R2 = 0.80). IVOX CO2 removal was only 40 ml/min at normocapnia (40 mm Hg) but increased to 91 ml/min when PaCO2 was 95 mm Hg. Both peak inspiratory pressure and minute ventilation of the IVOX/permissive hypercapnia group were significantly lower than the control group, 30 ± 4 mm Hg vs 51 ± 3 mm Hg and 3.9 ± 0.3 liters vs 8.4 ± 0.5 liters (P < 0.05) respectively. CO2 removal by IVOX can be substantially augmented under conditions of permissive hypercapnia, reducing the ventilatory requirements in an ovine model of acute smoke inhalation injury.

UR - http://www.scopus.com/inward/record.url?scp=0027936094&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027936094&partnerID=8YFLogxK

U2 - 10.1006/jsre.1994.1117

DO - 10.1006/jsre.1994.1117

M3 - Article

C2 - 8041157

AN - SCOPUS:0027936094

VL - 57

SP - 99

EP - 105

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -