Intravascular membrane oxygenation and carbon dioxide removal - A new application for permissive hypercapnia?

J. B. Zwischenberger, C. S. Cox, D. Graves, A. Bidani

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Pressure limited ventilation or 'lung rest' may prevent further exacerbation of acute lung injury from high airway pressures. A therapeutic goal of an intracorporeal oxygenation and carbon dioxide removal device (IVOX) is reduction of airway pressures. We noted increased IVOX CO2 removal as mixed venous CO2 increased in experimental animals. However, we recognize the limited clinical utility of removing approximately 30% of venous CO2. Therefore, intentional hypoventilation to limit airway pressures (mild permissive hypercapnia) was used in 5 patients with respiratory failure, and again we noted improved CO2 removal with increasing mixed venous CO2 concentrations. Preliminary calculations demonstrate that a CO2 gradient of approximately 70 mm Hg is needed to remove 100 ml CO2/min. The use of more aggressive permissive hypercapnia protocols with IVOX may permit further reduction in airway pressure without problems of severe respiratory acidosis.

Original languageEnglish
Pages (from-to)115-120
Number of pages6
JournalThoracic and Cardiovascular Surgeon
Issue number3
StatePublished - 1992


  • intracorporeal oxygenation
  • intravascular oxygenator
  • membrane oxygenator

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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