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7 BICARBONATE REMOVAL DURING ACETATE HEMODIALYSIS AND ITS POSSIBLE USE IN RESPIRATORY FAILURE OF THE NEWBORN: ANIMAL STUDIES ON EXTRACORPOREAL BICARBONATE/C02-REMOVAL (ecBICC02R) AND APNEIC OXYGENATION

Extracorporeal techniques for respiratory support in the newborn are feasible and established as neonatal extracorporeal membrane oxygenation (ECMO). It has been shown however, that even in severly damaged lungs, sufficient oxygenation (apneic oxygenation) can be maintained by only removing CO2 with an artificial lung, a technique called extracorporeal CO2-removal (ECCO2R).During routine acetate hemodialysis in 22 patients with end stage renal disease an overall CO2-removal of 79.1 +/- 15.1 ml was measured, at least one third of the entire metabolic CO2-production. For total metabolic CO2-removal, acetate dialysate (22mmol/l) was modified with phosphate buffer (2mmol/l), lactate (5mmol/l) and sodium hydroxide (7mmol/l) to compensate for the bicarbonate loss. In 6 sheep, apneic oxygenation could be achieved with blood flow rates as low as 10-15 ml/kg/min for 4-6 hours.These data suggest that a hemodialysis procedure for bicarbonate and CO2elimination (ecBICCO2R) is an efficient method for CO2-removal necessitating much lower blood flow rates than other techniques presently used. An other advantage of this technique is the maintainence of acid-base, electrolyte and fluid balance as well as renal replacement in multiple organ failure.