Patent Application
20210252205
This patent application claims priority from Italian patent application no. 102018000005641 filed on 23 May 2018, the entire disclosure of which is incorporated herein by reference.
The present invention relates to an extracorporeal circuit for removing CO2 from blood.
The extracorporeal removal of CO2 from blood is necessary when the pulmonary function has to be supplemented, even only partially, when said function is compromised due to various pathologies.
In general, extracorporeal circuits for removing CO2 from blood entail drainage of the patient's blood into an extracorporeal circuit to be artificially oxygenated and decarbonated by means of a gas exchanger, such as an oxygenator. More specifically, in a veno-venous extracorporeal system, part of the venous blood which returns towards the right atrium of the heart is collected in the extracorporeal circuit and pumped into the oxygenator, from which it is then reinfused into the venous system.
The most commonly used oxygenator devices are membrane oxygenators in which the blood and the oxygen (or an oxygen-rich mixture) are made to flow on opposite sides of a membrane. This type of apparatus therefore acts on the quantity of CO2 dissolved in the blood which is actually a limited portion of the total CO2 content. In fact, it is known that 90% of the CO2 transported in the blood is in the form of bicarbonate ions according to the chemical balance (I) shown below.
CO2+H2O↔H2CO3↔H++HCO3− (I)
A solution for increasing removal of CO2 from blood by means of membrane oxygenators is that of intervening on the chemical balance (I) inducing an increase in the percentage of gaseous CO2. This increase in the concentration of gaseous CO2 subject to removal by the oxygenator favours removal of the total CO2.
One of the ways of intervening on the chemical balance (I) in favour of the gaseous CO2 is exogenous acidification. Said acidification is achieved by adding an acid substance in the extracorporeal circuit upstream of the oxygenator.
By converting the bicarbonate ions into dissolved CO2, the acidification increases the transmembrane pCO2 gradient, and therefore increases the transfer of CO2 through the oxygenator membrane. Exogenous acidification of the blood allows removal of the equivalent of 50% of the total production of CO2 of an adult male from extracorporeal blood at a rate of 250 ml/min.
Alternatively, a technique based on ventilation of the acidified dialysate has also been developed, which has shown a slightly lower efficiency (10-15%) compared to direct ventilation of the blood, but reduces the exogenous contact surface with the blood and can therefore offer possible advantages.
In both cases, the acidification is obtained by infusion of a concentrated solution of metabolizable organic acids, for example lactic acid. However, when infused exogenously, despite their high clearance, said acids can cause a certain level of metabolic acidosis and an increase in the production of total corporeal CO2, thus reducing the effectiveness of the extracorporeal removal of CO2 in reducing the minute ventilation of the patient.
Therefore, as will be obvious to a person skilled in the art, said addition of acid can reduce the effectiveness of the extracorporeal technique of CO2 removal and can entail a series of drawbacks that must be dealt with in order not to alter the patient's homeostasis.
The object of the present invention is therefore to produce an extracorporeal circuit for removing CO2 from blood, able to increase removal of the CO2 by intervening on the chemical balance (I) without recourse to the administration of an exogenous acid, while at the same time guaranteeing high safety levels.
Said object is achieved by the present invention relative to an extracorporeal circuit for removing CO2 from blood, the essential characteristics of which are described in claim 1, and the preferred and/or auxiliary characteristics of which are described in the dependent claims.
In particular, an extracorporeal circuit is provided for removing CO2 from blood comprising a withdrawal line for withdrawing blood from the patient, a filtration unit for the production of plasma water and a line for returning the blood to the patient defining a main circuit. The extracorporeal circuit further comprises a decarbonation group comprising means for removal of a fraction of said plasma water, a cationic resin charged with H+ ions adapted to generate acid plasma water, a CO2 exchanger, means for infusion of the acid plasma water upstream of the CO2 exchanger and means for the infusion of a solution of electrolytes downstream of said CO2 exchanger.
Advantageously, the use of a cationic resin charged with H+ ions to treat the plasma water, for example a dialysate or an ultrafiltrate, allows replacement, in a controlled manner, of the positively charged ions present in said solution, without the addition of exogenous acids.
In particular, the H+ charged cationic resin is able to replace the calcium, sodium, potassium and magnesium ions present in the plasma water with hydrogen ions, leading to a regional acidification of this solution forming an acid solution.
The regional acidification allows improvement in the extracorporeal removal of carbon dioxide, acting on the chemical balance (I) shown above.
Furthermore, the H+ charged cationic resin, by removing sodium ions above all, since they are present in greater quantities in the blood, allows greater acidification of the plasma water than the systems known in the art with the same volume of liquid treated. A further advantage of the use of an H+ charged cationic resin consists in the fact that said resin works without the addition of exogenous liquids, simplifying the hydroelectrolytic balance of the blood after the treatment before reinfusion in the patient.
The device of the invention, acting on the concentration of cations in the blood, can furthermore be used not only for removing CO2 but also to simultaneously carry out a continuous renal replacement therapy.
Continuous renal replacement therapy (CRRT) is an extracorporeal support technique widely used in the treatment of patients affected by acute kidney failure and other pathological conditions like sepsis and multi-organ dysfunction. During CRRT the patient's blood is treated through diffusion, conduction and absorption mechanisms.
In one embodiment, the filtration unit is a filter selected from the group consisting of a haemodialysis filter, a haemofilter and a dialyser.
Preferably the cationic resin is a resin provided with sulphonic groups or carboxylic groups.
For a better understanding of the invention, it will now be described in detail for purely illustrative non-limiting purposes with the help of the figures of the attached drawings, in which:
In
The circuit 1 comprises a withdrawal line for withdrawing blood 2 from the patient, on which a pump 3 acts, for example a peristaltic pump, a filtration unit 6, for example a haemodialysis filter, a decarbonating group 4 and a line for returning the blood 5 to the patient. The withdrawal line for withdrawing blood 2 from the patient, the filtration unit 6, and the line for returning the blood 5 to the patient define a main circuit 40.
The haemodialysis filter 6 is connected to a secondary circuit 7 for recirculation of the plasma water 30, in this case dialysate, on which a pump 8 acts.
The decarbonating group 4 comprises a cationic resin charged with H+ ions 10 adapted to generate acid plasma water 30a positioned downstream of the pump 8 on the secondary circuit 7 of the plasma water 30.
The decarbonating group 4 further comprises an oxygenator 9 arranged on the main circuit 40 downstream of the haemodialysis filter 6 along the return line 5 for returning the blood to the patient.
Advantageously the cationic resin 10 is able to retain the calcium, potassium and magnesium ions but above all the sodium ions, present in large quantities in the plasma water 30, replacing them with H+ ions and generating acid plasma water 30a at the resin outlet.
Advantageously the acidification of the plasma water 30 causes a shift in the chemical balance (I) in favour of the gaseous CO2 in the acid plasma water 30a in recirculation. The gaseous CO2 is then removed by the action of the oxygenator 9, for example a bubble oxygenator. In this way, it is possible to improve removal of the CO2 from the plasma water 30a.
The acid plasma water 30a is returned to the haemodialysis filter 6, inside which it will function as a dialysis liquid, by means of the line 15. The blood flowing out of the haemodialysis filter 6 is then deprived of the CO2 by the oxygenator 9. The blood flowing out of the oxygenator 9 will therefore have an electrolytic imbalance due to the removal of cations by the cationic resin 10. To re-balance the concentration of the electrolytes in the blood before reinfusion to the patient, downstream of the oxygenator 9, along the line 5, means 11 are provided for the reinfusion of sodium, potassium, calcium and magnesium ions in solution to re-balance the quantity of cations lost at the level of the cationic resin 10. Said means 11 for the reinfusion of ions consist for example in one or more sacs 11a each containing an electrolytic solution, a pump 11b and an infusion line 11c. For example, an electrolytic solution comprising NaOH, KOH, NaCl or NaHCO3 can be infused and, separately, a solution comprising calcium ions and magnesium ions. Said solutions can also include glucose if CRRT is also performed.
The circuit 1 further comprises, upstream of the cationic resin 10, means 12 for removing part of the plasma water. Said means 12 for removing part of the plasma water consist, for example, of a removal line 12a, a peristaltic pump 12b and a discard tank 12c.
The removal of part of the plasma water is necessary to compensate for the increase in volume of the plasma water, which occurs following addition of the electrolytic solution through the means 11. Therefore, to respect the hydroelectric balance of the system, the quantity of water removed by the means 12 must be equal to the quantity of water reinfused with the electrolytic solution through the means 11.
Likewise, the electrolytic solution reinfused with the means 11 must contain a quantity of sodium, potassium, calcium and magnesium equal to that removed with the cationic resin 10 plus that removed with the means 12 for removing part of the plasma water.
Alternatively, when the circuit of the invention is used, not only for removing the CO2 but also for renal therapy, the quantity of water and electrolytes removed by the means 12 can be different from that reinfused with the means 11.
Lastly, the blood flowing out of the haemodialysis filter 6 is returned to the patient by means of a line for returning the blood 5.
In the circuit of
In particular,
The acid plasma water 30a flowing out of the cationic resin 10 is recombined by means of the line 18 with the plasma water 30b and then conveyed along the line 15 to the oxygenator 9 which, in this embodiment, is on the secondary circuit 7.
Advantageously, this embodiment reduces the exogenous contact surface between the blood and the extracorporeal circulation system and reduces the pH variations to which the blood is exposed.
In this embodiment, for example, the blood flow leaving the patient can be set to 200 ml/min and the flow of the ultrafiltrate from the haemodialysis filter can be set to 400-1000 ml/min.
In
In all the embodiments of the present invention, a gas trap can also be inserted downstream of the cationic resin 10 but upstream of the oxygenator 9 to further favour elimination of the carbon dioxide and prevent the accumulation of gas.
All the embodiments of the present invention can furthermore include a regional blood anticoagulation system. For example, the circuit of
The circuit of
Alternatively, in the circuit 500 of
| Number | Date | Country | Kind |
|---|---|---|---|
| 102018000005641 | May 2018 | IT | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/IB2019/054288 | 5/23/2019 | WO | 00 |
