Pulmonary and Respiratory Medicine International Journal (PRMIJ)

Open Access Journal

Frequency: Bi-Monthly

ISSN 2631-0120

Volume : 1 | Issue : 1

Research

Combined use of extracorporeal carbon dioxide removal (ECCO2-R) and Noninvasive Mechanical Ventilation in hypercapnic acute respiratory failure due to COPD exacerbations in patients at risk of NIMV failure: a rationale of use

Longobardi S,1 Bocchino V,2 Squillante F,3 Mazzarella G,4 Schettini C1

1Azienda Ospedaliero-Universitaria Regionale San Carlo , Potenza
2Respiratory Intermediate-Intensive Care Unit, Azienda Ospedaliera Monaldi, Italy
3Respiratory Intermediate-Intensive Care Unit, Azienda Ospedaliera Monaldi, Italy
4Second University of Naples, Cardiothoracic and Respiratory Sciences, Italy
5Respiratory Physiophatology and Pulmonary Critical Care Unit, Azienda Ospedaliero Universitaria Regionale, Italy

Received: February 04, 2018 | Published: February 19, 2018

Correspondence: Longobardi S, Respiratory Fisiophatology and Pulmonary Critical Care Unit, Azienda Ospedaliero Universitaria Regionale “San Carlo”, Potenza, Italy, Tel 00393493683123, Email salvatoredlongobardi@gmail.com

Citation: Longobardi S, Bocchino V, Squillante F, et al. Combined use of extracorporeal carbon dioxide removal (ECCO2-R) and Noninvasive Mechanical Ventilation in hypercapnic acute respiratory failure due to COPD exacerbations in patients at risk of NIMV failure: a rationale of use. Pulm Resp Med Int J. (2018);1(1):3-4. DOI: 10.30881/prmij.00002

Introduction

Acute respiratory failure in patients with Chronic Obstructive Pulmonary Disease (COPD) is characterized by high levels of hypercapnia. To date, state-of-art treatment includes mechanical ventilation support. Our study was designed from a matched cohort study with historical control conducted by Chandra et al, Del Sorbo et al.1,2 in 2014 that provided the rationale to use ECCO2-R in hypercapnic respiratory failure and respiratory acidosis non responsive at NIV at risk of endotracheal intubation (E.T.I).

Aims

The aims of this study are to evaluate the effectiveness of non-invasive ventilation and extracorporeal carbon dioxide removal in hypercapnic respiratory failure with respiratory acidosis in COPD patients, and to prevent endotracheal intubation and all its potential complications (pneumonia, difficulty weaning, tracheostomy, - prolonged hospitalization).3

Setting: RICU & IICU

Methods

We enrolled 10 consecutive patients admitted at IICUs/RICU, diagnosed with COPD in ARF, age 18-80 y.o.; BMI<35, arterial CO2 >20% from basal value; arterial pH >7.15 & <7.30; respiratory rate >30 breaths/min, paradoxical abdominal movements. On admission - SOFA, APACHEII & SAPSII scores were captured.

We focused on three primary end points:

1) Reduction of arterial CO2, increasing of arterial pH and reduction of RR

2) Prevention of endotracheal intubation

3) Providing early support to patient weaning4,5

Results

Eight of ten patients avoided E.T.I. and were easily weaned from NIMV with arterial CO2 levels returning to basal value after 48h of treatment. One subject was not responsive to NIMV and was treated with invasive ventilation. One subject was removed from treatment for hypersensitivity to heparin and bleeding from arterial catheter.

Conclusion

This study supports the use of non-invasive mechanical ventilation in combination with ECCO2R in hypercapnic respiratory failure due to COPD.6 In addition we suggest assessing the effectiveness of noninvasive ventilation to reduce potential complications and time of hospitalization in this patient population.

References

  1. Chandra D , et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008 . Am J Respir Crit Care Med .2012 ; 185- 2: 152 – 159.
  2. Del Sorbo,L., etal., Extracorporeal CO2 Removal In Hypercapnic Patients At Risk Of Noninvasive Ventilation Failure: A Matched Cohort Study With Historical Control. Crit Care Med,2014.  
  3. Quinnell TG, et al Prolonged invasive ventilation following acute ventilatory failure in COPD:weaning results, survival, and the role of noninvasive ventilation Chest . 2006 ; 129 - 1: 133 – 139.
  4. Nausherwan K. Burki et al. A novel extracorporeal CO2 system: result of a pilot study of hypercapnic respiratory failure in COPD patients. CHEST 2013; 143-3:678–686, Del Sorbo et al. Extracorporeal CO2 Removal in Hypercapnic Patients at risk of Non-Invasive Ventilation Failure: a Matched cohort study with historical control. Critical Care Med 2014.
  5. Lewandowski, K., Extracorporeal membrane oxygenation for severe acute respiratory failure. Crit Care, 2000. 4(3): p. 156-68.
  6. Hill, J.D., et al., Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med, 1972. 286(12): p. 629-34.
Copyright© 2018 Longobardi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.