Understanding hypoxemia on ECCO2R: back to the alveolar gas equation
Extracorporeal CO2 removal (ECCO2R) is a promising technique for ARDS and for severe acute exacerbations of COPD . However, ECCO2R carries its own risk of complications and side effects. Beyond hemorrhagic and thrombotic complications and hemolysis, the occurrence of progressive hypoxemia has been reported in COPD patients treated by ECCO2R, leading to a tracheal intubation rate of 28% in the prospective series from Braune et al. . Obviously, progressive hypoxemia can be explained by pulmonary complications such as evolving infiltrates, even if other factors such as modification of the respiratory quotient have been proposed [2, 3]. Accordingly, we illustrate such a mechanism, intrinsically linked to the ECCO2R technique and not involving any worsening of lung function by itself.
No specific funding has been dedicated to this publication.
Compliance with ethical standards
Conflicts of interest
Jean-Luc Diehl received fees from Xenios and Alung for consulting and lectures. Funding for research purposes: Alung Technologies (EPHEBE study, NCT02586948). Alain Mercat received fees from ALung for lectures. Antonio Pesenti received fees from Xenios and Getinge for consulting and lectures.
Treatment with ECCO2R was performed as part of a specific registry (Registry on the EXperience of Extracorporeal CO2 Removal in Intensive Care Units, NCT02965079), benefiting from an approval (07 March 2016) from the Ethics Committee of the French Intensive Care Society.
- 2.Braune S, Sieweke A, Brettner F, Staudinger T, Joannidis M, Verbrugge S et al (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case–control study. Intensive Care Med 42(9):1437–1444CrossRefGoogle Scholar