Electrolyte shifts across the artificial lung in patients on extracorporeal membrane oxygenation: interdependence between partial pressure of carbon dioxide and strong ion difference.

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 ∆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.

High positive end-expiratory pressure: only a dam against oedema formation?

INTRODUCTION: Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation. METHODS: Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT). RESULTS: Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01). CONCLUSIONS: High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.

Advanced controlling of anaerobic digestion by means of hierarchical neural networks.

In this work several feed-forward back propagation neural networks (FFBP) were trained in order to model, and subsequently control, methane production in anaerobic digesters. To produce data for the training of the neural nets, four anaerobic continuous stirred tank reactors were operated in steady-state conditions at organic loading rates (Br) of about 2 kg m(-3) d(-1) chemical oxygen demand, and disturbed by pulse-like increase of the organic loading rate. For the pulses additional carbon sources like flour, sucrose, 1,2-diethylen glycol or vegetable oil were added to the basic feed, which consisted of surplus and primary sludge of a local waste-water treatment plant, to increase the chemical oxygen demand. Measured parameters were: gas composition, methane production rate, volatile fatty acid concentration, pH, redox potential, volatile suspended solids and chemical oxygen demand of feed and effluent. A hierarchical system of nets was developed and embedded in a decision support system to find out which is the best feeding profile for the next time steps in advance. A 3-3-1 FFBP simulated the pH with a regression coefficient of 0.82. A 9-3-3 FFBP simulated the volatile fatty acid concentration in the sludge with a regression coefficient of 0.86. And a 9-3-2 FFBP simulated the gas production and gas composition with a regression coefficient of 0.90 and 0.80, respectively. A lab-scale anaerobic continuous stirred tank reactor controlled by this tool was able to maintain a methane concentration of about 60% at a rather high gas production rate of between 5 and 5.6 m3 m(-3) d(-1).