Sodium bicarbonate buffer for weaning from venovenous extracorporeal membrane oxygenation in patients with hypercapnic respiratory failure and acute renal failureopen access
- Authors
- Kim, Sua; Hwang, Jinwook; Kim, Je Hyeong
- Issue Date
- 10월-2022
- Publisher
- WOLTERS KLUWER MEDKNOW PUBLICATIONS
- Keywords
- Bicarbonate buffer; respiratory acidosis; venovenous extracorporeal membrane oxygenation
- Citation
- ANNALS OF THORACIC MEDICINE, v.17, no.4, pp.237 - 240
- Indexed
- SCIE
SCOPUS
- Journal Title
- ANNALS OF THORACIC MEDICINE
- Volume
- 17
- Number
- 4
- Start Page
- 237
- End Page
- 240
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/146588
- DOI
- 10.4103/atm.atm_265_22
- ISSN
- 1817-1737
- Abstract
- Although the routine use of alkali buffer is not recommended in patients with respiratory acidosis, some patients may benefit from its administration. A 42-year-old man was treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) and continuous venovenous hemodiafiltration (CVVHDF) due to necrotizing pneumonia and emphysematous cystitis with Klebsiella pneumoniae. Although the sweep gas flow rate of the VV-ECMO was gradually reduced, he failed to wean off VV-ECMO due to respiratory acidosis, followed by tachycardia and tachypnea on the 63rd day of VV-ECMO. Therefore, we mixed sodium bicarbonate in the replacement fluid of CVVHDF for 5 days to avoid an intolerable decrease in blood pH after discontinuing the VV-ECMO sweep gas. When the serum bicarbonate concentration was > 30 mmol/L and pH was maintained at > 7.30 with a PCO2 of > 60 mmHg, VV-ECMO was finally decannulated. Sodium bicarbonate buffer through the replacement of CVVHDF fluid facilitated VV-ECMO weaning in a patient with hypercapnic respiratory failure.
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