Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation
To evaluate whether extracorporeal carbon dioxide removal by means of a pumpless extracorporeal lung-assist (PECLA) device could be an effective and safe alternative to invasive mechanical ventilation in patients with chronic pulmonary disease and acute hypercapnic ventilatory failure not responding to noninvasive ventilation (NIV).
In this multicentre, retrospective study, 21 PECLA patients were compared with respect to survival and procedural outcomes to 21 matched controls with conventional invasive mechanical ventilation. Matching criteria were underlying diagnosis, age, Simplified Acute Physiology Score II and pH at ICU admission.
Of the 21 patients treated with PECLA, 19 (90 %) did not require intubation. Median PaCO2 levels and pH in arterial blood prior to PECLA were 84.0 mmHg (54.2–131.0) and 7.28 (7.10–7.41), respectively. Within 24 h, median PaCO2 levels and pH had significantly improved to 52.1 (33.0–70.1; p < 0.001) and 7.44 (7.27–7.56; p < 0.001), respectively. Two major and seven minor bleeding complications related to the device occurred. Further complications were one pseudoaneurysm and one heparin-induced thrombocytopenia type 2. Compared to the matched control group, there was a trend toward a shorter hospital length of stay in the PECLA group (adjusted p = 0.056). There was no group difference in the 28-day (24 % vs. 19 %, adjusted p = 0.845) or 6-month mortality (33 % vs. 33 %).
In this study the use of extracorporeal carbon dioxide removal allowed avoiding intubation and invasive mechanical ventilation in the majority of patients with acute on chronic respiratory failure not responding to NIV. Compared to conventional invasive ventilation, short- and long-term survivals were similar.
KeywordsEndotracheal intubation Mechanical ventilation Extracorporeal Carbon dioxide removal COPD Hypercapnia Acute respiratory failure
- 7.Ram FS, Picot J, Lightowler J, Wedzicha JA (2004) Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst RevCD004104Google Scholar
- 8.Funk GC (2012) [Non-invasive mechanical ventilation in COPD.]. Med Klin Intensivmed NotfmedGoogle Scholar
- 17.Global Initiative for Chronic Obstructive Lung Disease (2010) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease http://www.goldcopd.com
- 19.Moscatelli A, Ottonello G, Nahum L, Lampugnani E, Puncuh F, Simonini A, Tumolo M, Tuo P (2010) Noninvasive ventilation and low-flow veno-venous extracorporeal carbon dioxide removal as a bridge to lung transplantation in a child with refractory hypercapnic respiratory failure due to bronchiolitis obliterans. Pediatr Crit Care Med 11:e8–12PubMedCrossRefGoogle Scholar
- 22.Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, Haverich A, Hoeper MM, Warnecke G (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care MedGoogle Scholar
- 32.Stewart NI, Jagelman TA, Webster NR (2011) Emerging modes of ventilation in the intensive care unit. Br J AnaesthGoogle Scholar