RATIONALE: Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH. However, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia. OBJECTIVES: To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through Extracorporeal Chloride Removal by Electrodialysis (CRe-ED). METHODS: Ten swine (6 treatments, 4 controls) were sedated, mechanically ventilated and connected to an electrodialysis extracorporeal device capable of removing selectively chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started in order to restore pH. MEASUREMENTS AND MAIN RESULTS: During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26±5 mEq/L within 6 hours (final pH=7.36±0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH=7.29±0.03, p<0.001). During metabolic acidosis, electrodialysis reduced plasma chloride concentration by 15±3 mEq/L within 4 hours (final pH=7.34±0.07). No effective compensatory response occurred in controls (final pH=7.11±0.08; p<0.001). No complications occurred. CONCLUSIONS: We described the first in-vivo application of an extracorporeal system targeted to correct severe acidemia by lowering plasma chloride concentration. The CRe-ED proved to be feasible, safe, and effective. Further studies are warranted to assess its performance in presence of impaired respiratory and renal functions.

Extracorporeal Chloride Removal by Electrodialysis (CRe-ED): A Novel Approach to Correct Acidemia / A. Zanella, P. Caironi, L. Castagna, E. Rezoagli, D. Salerno, E. Scotti, V. Scaravilli, S.A. Deab, T. Langer, T. Mauri, M. Ferrari, D. Dondossola, M. Chiodi, F. Zadek, F. Magni, S. Gatti, L. Gattinoni, A.M. Pesenti. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - (2019). [Epub ahead of print] [10.1164/rccm.201903-0538OC]

Extracorporeal Chloride Removal by Electrodialysis (CRe-ED): A Novel Approach to Correct Acidemia

A. Zanella;E. Scotti;V. Scaravilli;T. Langer;T. Mauri;M. Ferrari;D. Dondossola;F. Zadek;
2019

Abstract

RATIONALE: Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH. However, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia. OBJECTIVES: To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through Extracorporeal Chloride Removal by Electrodialysis (CRe-ED). METHODS: Ten swine (6 treatments, 4 controls) were sedated, mechanically ventilated and connected to an electrodialysis extracorporeal device capable of removing selectively chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started in order to restore pH. MEASUREMENTS AND MAIN RESULTS: During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26±5 mEq/L within 6 hours (final pH=7.36±0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH=7.29±0.03, p<0.001). During metabolic acidosis, electrodialysis reduced plasma chloride concentration by 15±3 mEq/L within 4 hours (final pH=7.34±0.07). No effective compensatory response occurred in controls (final pH=7.11±0.08; p<0.001). No complications occurred. CONCLUSIONS: We described the first in-vivo application of an extracorporeal system targeted to correct severe acidemia by lowering plasma chloride concentration. The CRe-ED proved to be feasible, safe, and effective. Further studies are warranted to assess its performance in presence of impaired respiratory and renal functions.
acidosis; chloride; electrodyalisis; electrolytes; extracorporeal circulation
Settore MED/41 - Anestesiologia
2019
25-set-2019
Article (author)
File in questo prodotto:
File Dimensione Formato  
464_zanella_rccm.201903-0538oc.pdf

accesso aperto

Tipologia: Post-print, accepted manuscript ecc. (versione accettata dall'editore)
Dimensione 739.92 kB
Formato Adobe PDF
739.92 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/703943
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 16
social impact