Electrolyte shifts across the artificial lung in patients on extracorporeal membrane oxygenation: Interdependence between partial pressure of carbon dioxide and strong ion difference
| Autor: | Pietro Caironi, Luciano Gattinoni, Loredana Zani, Eleonora Scotti, Eleonora Carlesso, Alessandro Protti, Monica Chierichetti, Thomas Langer |
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| Přispěvatelé: | Langer, T, Scotti, E, Carlesso, E, Protti, A, Zani, L, Chierichetti, M, Caironi, P, Gattinoni, L |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Anions Male medicine.medical_specialty Partial Pressure medicine.medical_treatment Analytical chemistry chemistry.chemical_element Electrolyte Respiratory failure Critical Care and Intensive Care Medicine Oxygen Artificial lung Electrolytes chemistry.chemical_compound Chlorides Stewart approach Gas exchange medicine Extracorporeal membrane oxygenation Humans business.industry Sodium Hemoglobin A Partial pressure Carbon Dioxide Hydrogen-Ion Concentration Electrolyte shift Acid-base equilibrium Surgery chemistry Carbon dioxide Arterial blood Female Acid–base reaction business |
| Zdroj: | Journal of Critical Care. 30:2-6 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/j.jcrc.2014.09.013 |
| Popis: | Purpose: Partial pressure of carbon dioxide (Pco2), strong ion difference (SID), and total amount of weak acids independently regulate pH. When blood passes through an extracorporeal membrane lung, Pco2 decreases. Furthermore, changes in electrolytes, potentially affecting SID, were reported. We analyzed these phenomena according to Stewart's approach. Methods: Couples of measurements of blood entering (venous) and leaving (arterial) the extracorporeal membrane lung were analyzed in 20 patients. Changes in SID, Pco2, and pH were computed and pH variations in the absence of measured SID variations calculated. Results: Passing from venous to arterial blood, Pco2 was reduced (46.5 ± 7.7 vs 34.8 ± 7.4 mm Hg, P < .001), and hemoglobin saturation increased (78 ± 8 vs 100% ± 2%, P < .001). Chloride increased, and sodium decreased causing a reduction in SID (38.7 ± 5.0 vs 36.4 ± 5.1 mEq/L, P < .001). Analysis of quartiles of {increment}Pco2 revealed progressive increases in chloride (P < .001), reductions in sodium (P < .001), and decreases in SID (P < .001), at constant hemoglobin saturation variation (P = .12). Actual pH variation was lower than pH variations in the absence of measured SID variations (0.09 ± 0.03 vs 0.12 ± 0.04, P < .001). Conclusions: When Pco2 is reduced and oxygen added, several changes in electrolytes occur. These changes cause a Pco2-dependent SID reduction that, by acidifying plasma, limits pH correction caused by carbon dioxide removal. In this particular setting, Pco2 and SID are interdependent. |
| Databáze: | OpenAIRE |
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