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The level of partial pressure of carbon dioxide affects organ perfusion in respiratory failure patients undergoing pressure support ventilation with venovenous extracorporeal membrane oxygenation: a prospective study

Year: 2024

Type: article

Abstract: We evaluated the influence of different partial carbon dioxide pressure (PaCO 2 ) levels on organ perfusion in patients with respiratory failure receiving pressure-support ventilation with veno-venous extracorporeal membrane oxygenation (V-V ECMO). In this twelve patients prospective study, ECMO gas-flow was decreased from baseline (PaCO 2 < 40 mmHg) until PaCO 2 increased by 5–10 mmHg (High-CO 2 phase). Resistance indices of gut, spleen, and snuffbox artery, the peripheral perfusion index (PPI), and heart rate variability were measured at baseline and High-CO 2 phase. When PaCO 2 increased from 36 (36–37) mmHg at baseline to 42 (41–43) mmHg in the High-CO 2 phase ( p < 0.001), PPI decreased significantly ( p = 0.026). The snuffbox artery ( p = 0.022), superior mesenteric artery ( p = 0.042), and spleen ( p = 0.012) resistance indices increased significantly. The root mean square of successive differences (RMSSD) decreased from 19.5(18.1–22.7) to 15.9(14.4–18.6) ms ( p = 0.034), and the ratio of low-frequency to high-frequency components(LF/HF) increased from 0.47 ± 0.23 to 0.70 ± 0.38 ( p = 0.013). High PaCO 2 might cause decreased peripheral tissue and visceral organ perfusion through autonomic nervous system in patients with respiratory failure undergoing PSV with V-V ECMO.

Source: BMC Pulmonary Medicine

DOI: 10.1186/s12890-024-03238-9