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Antonio Pesenti - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Carbon Dioxide Removal ecco2r in patients with acute respiratory failure
Intensive Care Medicine, 2017Co-Authors: Andrea Morelli, Lorenzo Del Sorbo, Eddy Fan, Antonio Pesenti, Marco V RanieriAbstract:To review the available knowledge related to the use of ECCO2R as adjuvant strategy to mechanical ventilation (MV) in various clinical settings of acute respiratory failure (ARF). Expert opinion and review of the literature. ECCO2R may be a promising adjuvant therapeutic strategy for the management of patients with severe exacerbations of COPD and for the achievement of protective or ultra-protective ventilation in patients with ARDS without life-threatening hypoxemia. Given the observational nature of most of the available clinical data and differences in technical features and performances of current devices, the balance of risks and benefits for or against ECCO2R in such patient populations remains unclear ECCO2R is currently an experimental technique rather than an accepted therapeutic strategy in ARF—its safety and efficacy require confirmation in clinical trials.
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extracorporeal Carbon Dioxide Removal enhanced by lactic acid infusion in spontaneously breathing conscious sheep
Anesthesiology, 2016Co-Authors: Vittorio Scaravilli, Alberto Zanella, Antonio Pesenti, Stefan Kreyer, Slava M Belenkiy, Katharina Linden, Michael A Dubick, Leopoldo C Cancio, Andriy I BatchinskyAbstract:Background The authors studied the effects on membrane lung Carbon Dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal Carbon Dioxide Removal (ECCO2R) technique enhanced by acidification (acid load Carbon Dioxide Removal [ALCO2R]) via lactic acid. Methods Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung Carbon Dioxide extraction, total Carbon Dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. Results ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung Carbon Dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total Carbon Dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). Conclusions ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.
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An Innovative Technique For Extracorporeal Carbon Dioxide Removal Featuring An Electrodialysis Unit: An In-Vitro Experiment.
Intensive Care Medicine Experimental, 2015Co-Authors: Alberto Zanella, D. Ferlicca, S Abd El Aziz El Sayed Deab, S Colombo, S. Spina, Simone Sosio, Michele Introna, D Ceriani, Domenico Salerno, Antonio PesentiAbstract:Acidification of blood entering the membrane lung (ML) converts biCarbonate ions into dissolved gaseous CO2, increasing the pCO2 transmembrane gradient and thus the extracorporeal Carbon Dioxide Removal (ECCO2R) [1]. Extracorporeal blood acidification has previously been achieved by infusion of lactic acid, which proved to be effective in rising ECCO2R but determined a mild increase of total CO2 production and induced a slight degree of metabolic acidosis [2], thus limiting the overall effectiveness of such treatment.
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blood acidification enhances Carbon Dioxide Removal of membrane lung an experimental study
Intensive Care Medicine, 2009Co-Authors: Alberto Zanella, Vittorio Scaravilli, Nicolò Patroniti, Antonio Pesenti, F Pirrone, M Albertini, Stefano Isgro, M Costanzi, Beatrice VergnanoAbstract:Purpose Extracorporeal CO2 Removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert biCarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML.
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blood acidification enhances Carbon Dioxide Removal of membrane lung an experimental study
Intensive Care Medicine, 2009Co-Authors: Alberto Zanella, Vittorio Scaravilli, Nicolò Patroniti, Antonio Pesenti, F Pirrone, M Albertini, Stefano Isgro, M Costanzi, Beatrice VergnanoAbstract:Extracorporeal CO2 Removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert biCarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML. Six pigs were connected to an extracorporeal circuit comprising a ML. The extracorporeal blood flow was 500 ml/min, while the gas flow was 10 l/min. A 15-min continuous infusion of 0.5 N lactic acid was added to the extracorporeal blood flow before the ML at a rate of 1, 2 and 5 mEq/min. Between steps we waited for a reequilibration time of at least 30 min. Acid infusion at 0, 1, 2 and 5 mEq/min increased pCO2 (56.19 ± 7.92, 68.24 ± 11.73, 84.28 ± 11.17 and 136.66 ± 18.46 mmHg, respectively) and decreased pH (7.39 ± 0.05, 7.30 ± 0.05, 7.20 ± 0.05 and 6.91 ± 0.05, respectively). ML CO2 Removal increased 11, 23 and 70% during acid infusion at 1, 2 and 5 mEq/min, respectively. Blood acidification at the inlet of a ML with infusion of 1, 2 and 5 mEq/min of lactic acid can increase the CO2 Removal capacity of the ML up to 70%.
Alberto Zanella - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Carbon Dioxide Removal enhanced by lactic acid infusion in spontaneously breathing conscious sheep
Anesthesiology, 2016Co-Authors: Vittorio Scaravilli, Alberto Zanella, Antonio Pesenti, Stefan Kreyer, Slava M Belenkiy, Katharina Linden, Michael A Dubick, Leopoldo C Cancio, Andriy I BatchinskyAbstract:Background The authors studied the effects on membrane lung Carbon Dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal Carbon Dioxide Removal (ECCO2R) technique enhanced by acidification (acid load Carbon Dioxide Removal [ALCO2R]) via lactic acid. Methods Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung Carbon Dioxide extraction, total Carbon Dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. Results ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung Carbon Dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total Carbon Dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). Conclusions ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.
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An Innovative Technique For Extracorporeal Carbon Dioxide Removal Featuring An Electrodialysis Unit: An In-Vitro Experiment.
Intensive Care Medicine Experimental, 2015Co-Authors: Alberto Zanella, D. Ferlicca, S Abd El Aziz El Sayed Deab, S Colombo, S. Spina, Simone Sosio, Michele Introna, D Ceriani, Domenico Salerno, Antonio PesentiAbstract:Acidification of blood entering the membrane lung (ML) converts biCarbonate ions into dissolved gaseous CO2, increasing the pCO2 transmembrane gradient and thus the extracorporeal Carbon Dioxide Removal (ECCO2R) [1]. Extracorporeal blood acidification has previously been achieved by infusion of lactic acid, which proved to be effective in rising ECCO2R but determined a mild increase of total CO2 production and induced a slight degree of metabolic acidosis [2], thus limiting the overall effectiveness of such treatment.
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extracorporeal Carbon Dioxide Removal through ventilation of acidified dialysate an experimental study
Journal of Heart and Lung Transplantation, 2014Co-Authors: Alberto Zanella, Paolo Mangili, Sara Redaelli, Vittorio Scaravilli, Marco Giani, Simone Sosio, Luigi Castagna, F Pirrone, M Albertini, Nicolò PatronitiAbstract:Background Extracorporeal (EC) Carbon Dioxide (CO 2 ) Removal (ECCO 2 R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO 2 R. We evaluated an innovative ECCO 2 R technique based on ventilation of acidified dialysate. Methods Four swine were sedated, mechanically ventilated, and connected to a venovenous dialysis circuit (blood flow, 250 ml/min). The dialysate was recirculated in a closed loop circuit including a ML (gas flow, 10 liters/min) and then returned to the dialyzer. In each animal, 4 different dialysis flows (DF) of 200, 400, 600, and 800 ml/min were evaluated with and without lactic acid infusion (2.5 mEq/min); the sequence was completed 3 times. At the end of each step, we measured the volume of CO 2 R by the ML (Vco 2 ML) and collected blood and dialysate samples for gas analyses. Results Acid infusion substantially increased Vco 2 ML, from 33 ± 6 ml/min to 86 ± 7 ml/min. Different DFs had little effect on Vco 2 ML, which was only slightly reduced at DF 200 ml/min. The partial pressure of CO 2 of blood passing through the dialysis filter changed from 60.9 ± 3.6 to 37.1 ± 4.8 mm Hg without acidification and to 32.5 ± 5.3 mm Hg with acidification, corresponding to a pH increase of 0.18 ± 0.03 and 0.03 ± 0.04 units, respectively. Conclusions Ventilation of acidified dialysate efficiently increased ECCO 2 R of an amount corresponding to 35% to 45% of the total CO 2 production of an adult man from a blood flow as low as 250 ml/min.
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Regional blood acidification enhances extracorporeal Carbon Dioxide Removal: a 48-hour animal study.
Anesthesiology, 2014Co-Authors: Alberto Zanella, Paolo Mangili, Sara Redaelli, Vittorio Scaravilli, Marco Giani, D. Ferlicca, Diletta Scaccabarozzi, Federica Pirrone, Mariangela Albertini, Nicolò PatronitiAbstract:Background:Extracorporeal Carbon Dioxide Removal has been proposed to achieve protective ventilation in patients at risk for ventilator-induced lung injury. In an acute study, the authors previously described an extracorporeal Carbon Dioxide Removal technique enhanced by regional extracorporeal bloo
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blood acidification enhances Carbon Dioxide Removal of membrane lung an experimental study
Intensive Care Medicine, 2009Co-Authors: Alberto Zanella, Vittorio Scaravilli, Nicolò Patroniti, Antonio Pesenti, F Pirrone, M Albertini, Stefano Isgro, M Costanzi, Beatrice VergnanoAbstract:Purpose Extracorporeal CO2 Removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert biCarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML.
Marco Gaudiosi - One of the best experts on this subject based on the ideXlab platform.
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feasibility and safety of low flow extracorporeal Carbon Dioxide Removal to facilitate ultra protective ventilation in patients with moderate acute respiratory distress sindrome
Critical Care, 2016Co-Authors: Vito Fanelli, Michael Quintel, Marco Ranieri, Jordi Mancebo, Onnen Moerer, Scott Morley, Indalecio Moran, Francisco Parrilla, Andrea Costamagna, Marco GaudiosiAbstract:Background Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal Carbon Dioxide Removal (ECCO2R).
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feasibility and safety of low flow extracorporeal Carbon Dioxide Removal to facilitate ultra protective ventilation in patients with moderate acute respiratory distress sindrome
Critical Care, 2016Co-Authors: Vito Fanelli, Michael Quintel, Marco Ranieri, Jordi Mancebo, Onnen Moerer, Indalecio Moran, Francisco Parrilla, Andrea Costamagna, Scott W. Morley, Marco GaudiosiAbstract:Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal Carbon Dioxide Removal (ECCO2R). In fifteen patients with moderate ARDS, VT was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure – (Pplat) between 23 and 25 cmH2O. Low-flow ECCO2R was initiated when respiratory acidosis developed (pH 60 mmHg). Ventilation parameters (VT, respiratory rate, PEEP), respiratory compliance (CRS), driving pressure (DeltaP = VT/CRS), arterial blood gases, and ECCO2R system operational characteristics were collected during the period of ultra-protective ventilation. Patients were weaned from ECCO2R when PaO2/FiO2 was higher than 200 and could tolerate conventional ventilation settings. Complications, mortality at day 28, need for prone positioning and extracorporeal membrane oxygenation, and data on weaning from both MV and ECCO2R were also collected. During the 2 h run in phase, VT reduction from baseline (6.2 mL/kg PBW) to approximately 4 mL/kg PBW caused respiratory acidosis (pH < 7.25) in all fifteen patients. At steady state, ECCO2R with an average blood flow of 435 mL/min and sweep gas flow of 10 L/min was effective at correcting pH and PaCO2 to within 10 % of baseline values. PEEP values tended to increase at VT of 4 mL/kg from 12.2 to 14.5 cmH2O, but this change was not statistically significant. Driving pressure was significantly reduced during the first two days compared to baseline (from 13.9 to 11.6 cmH2O; p < 0.05) and there were no significant differences in the values of respiratory system compliance. Rescue therapies for life threatening hypoxemia such as prone position and ECMO were necessary in four and two patients, respectively. Only two study-related adverse events were observed (intravascular hemolysis and femoral catheter kinking). The low-flow ECCO2R system safely facilitates a low volume, low pressure ultra-protective mechanical ventilation strategy in patients with moderate ARDS.
Jan O. Friedrich - One of the best experts on this subject based on the ideXlab platform.
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Extracorporeal Carbon Dioxide Removal in patients with chronic obstructive pulmonary disease: a systematic review
Intensive care medicine, 2015Co-Authors: Michael C. Sklar, Francois Beloncle, Christina M. Katsios, Laurent Brochard, Jan O. FriedrichAbstract:Introduction Extracorporeal Carbon Dioxide Removal (ECCO2R) has been proposed for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) exacerbations, to avoid intubation or reduce length of invasive ventilation. Balance of risks, efficacy, and benefits of ECCO2R in patients with COPD is unclear.
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extracorporeal Carbon Dioxide Removal in patients with chronic obstructive pulmonary disease a systematic review
Intensive Care Medicine, 2015Co-Authors: Michael C. Sklar, Francois Beloncle, Christina M. Katsios, Laurent Brochard, Jan O. FriedrichAbstract:Extracorporeal Carbon Dioxide Removal (ECCO2R) has been proposed for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) exacerbations, to avoid intubation or reduce length of invasive ventilation. Balance of risks, efficacy, and benefits of ECCO2R in patients with COPD is unclear. We systematically searched MEDLINE and EMBASE to identify all publications reporting use of ECCO2R in COPD. We looked at physiological and clinical efficacy. A favorable outcome was defined as prevention of intubation or successful extubation. Major and minor complications were compiled. We identified 3123 citations. Ten studies (87 patients), primarily case series, met inclusion criteria. ECCO2R prevented intubation in 65/70 (93 %) patients and assisted in the successful extubation of 9/17 (53 %) mechanically ventilated subjects. One case–control study matching to noninvasively ventilated controls reported lower intubation rates and hospital mortality with ECCO2R that trended toward significance. Physiological data comparing pre- to post-ECCO2R changes suggest improvements for pH (0.07–0.15 higher), PaCO2 (25 mmHg lower), and respiratory rate (7 breaths/min lower), but not PaO2/FiO2. Studies reported 11 major (eight bleeds requiring blood transfusion of 2 units, and three line-related complications, including one death related to retroperitoneal bleeding) and 30 minor complications (13 bleeds, five related to anticoagulation, and nine clotting-related device malfunctions resulting in two emergent intubations). The technique is still experimental and no randomized trial is available. Recognizing selection bias associated with case series, there still appears to be potential for benefit of ECCO2R in patients with COPD exacerbations. However, it is associated with frequent and potentially severe complications. Higher-quality studies are required to better elucidate this risk–benefit balance.
Nicolò Patroniti - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Carbon Dioxide Removal through ventilation of acidified dialysate an experimental study
Journal of Heart and Lung Transplantation, 2014Co-Authors: Alberto Zanella, Paolo Mangili, Sara Redaelli, Vittorio Scaravilli, Marco Giani, Simone Sosio, Luigi Castagna, F Pirrone, M Albertini, Nicolò PatronitiAbstract:Background Extracorporeal (EC) Carbon Dioxide (CO 2 ) Removal (ECCO 2 R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO 2 R. We evaluated an innovative ECCO 2 R technique based on ventilation of acidified dialysate. Methods Four swine were sedated, mechanically ventilated, and connected to a venovenous dialysis circuit (blood flow, 250 ml/min). The dialysate was recirculated in a closed loop circuit including a ML (gas flow, 10 liters/min) and then returned to the dialyzer. In each animal, 4 different dialysis flows (DF) of 200, 400, 600, and 800 ml/min were evaluated with and without lactic acid infusion (2.5 mEq/min); the sequence was completed 3 times. At the end of each step, we measured the volume of CO 2 R by the ML (Vco 2 ML) and collected blood and dialysate samples for gas analyses. Results Acid infusion substantially increased Vco 2 ML, from 33 ± 6 ml/min to 86 ± 7 ml/min. Different DFs had little effect on Vco 2 ML, which was only slightly reduced at DF 200 ml/min. The partial pressure of CO 2 of blood passing through the dialysis filter changed from 60.9 ± 3.6 to 37.1 ± 4.8 mm Hg without acidification and to 32.5 ± 5.3 mm Hg with acidification, corresponding to a pH increase of 0.18 ± 0.03 and 0.03 ± 0.04 units, respectively. Conclusions Ventilation of acidified dialysate efficiently increased ECCO 2 R of an amount corresponding to 35% to 45% of the total CO 2 production of an adult man from a blood flow as low as 250 ml/min.
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Regional blood acidification enhances extracorporeal Carbon Dioxide Removal: a 48-hour animal study.
Anesthesiology, 2014Co-Authors: Alberto Zanella, Paolo Mangili, Sara Redaelli, Vittorio Scaravilli, Marco Giani, D. Ferlicca, Diletta Scaccabarozzi, Federica Pirrone, Mariangela Albertini, Nicolò PatronitiAbstract:Background:Extracorporeal Carbon Dioxide Removal has been proposed to achieve protective ventilation in patients at risk for ventilator-induced lung injury. In an acute study, the authors previously described an extracorporeal Carbon Dioxide Removal technique enhanced by regional extracorporeal bloo
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blood acidification enhances Carbon Dioxide Removal of membrane lung an experimental study
Intensive Care Medicine, 2009Co-Authors: Alberto Zanella, Vittorio Scaravilli, Nicolò Patroniti, Antonio Pesenti, F Pirrone, M Albertini, Stefano Isgro, M Costanzi, Beatrice VergnanoAbstract:Purpose Extracorporeal CO2 Removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert biCarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML.
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blood acidification enhances Carbon Dioxide Removal of membrane lung an experimental study
Intensive Care Medicine, 2009Co-Authors: Alberto Zanella, Vittorio Scaravilli, Nicolò Patroniti, Antonio Pesenti, F Pirrone, M Albertini, Stefano Isgro, M Costanzi, Beatrice VergnanoAbstract:Extracorporeal CO2 Removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert biCarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML. Six pigs were connected to an extracorporeal circuit comprising a ML. The extracorporeal blood flow was 500 ml/min, while the gas flow was 10 l/min. A 15-min continuous infusion of 0.5 N lactic acid was added to the extracorporeal blood flow before the ML at a rate of 1, 2 and 5 mEq/min. Between steps we waited for a reequilibration time of at least 30 min. Acid infusion at 0, 1, 2 and 5 mEq/min increased pCO2 (56.19 ± 7.92, 68.24 ± 11.73, 84.28 ± 11.17 and 136.66 ± 18.46 mmHg, respectively) and decreased pH (7.39 ± 0.05, 7.30 ± 0.05, 7.20 ± 0.05 and 6.91 ± 0.05, respectively). ML CO2 Removal increased 11, 23 and 70% during acid infusion at 1, 2 and 5 mEq/min, respectively. Blood acidification at the inlet of a ML with infusion of 1, 2 and 5 mEq/min of lactic acid can increase the CO2 Removal capacity of the ML up to 70%.