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Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: a proof-of-concept study
  1. Lara Pisani1,
  2. Stefano Nava1,
  3. Emilia Desiderio2,
  4. Mario Polverino2,
  5. Tommaso Tonetti3,
  6. V Marco Ranieri3
  1. 1 Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
  2. 2 Unità di Pneumologia,Dipartimento di Medicina, Scafati, Italy, Mauro Scarlato Hospital, Scafati, Campania, Italy
  3. 3 Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Critical Care Medicine,Policlinico di Sant’Orsola, Bologna, Italy, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
  1. Correspondence to Professor Stefano Nava, Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna 40126, Italy; stefanava{at}gmail.com

Abstract

Domiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO2) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We hypothesised that extracorporeal CO2 removal (ECCO2R) may lower their PaCO2. Ten patients hypercapnic despite ≥6 months of NIV underwent a 24-hour trial of ECCO2R. Six patients completed the ECCO2R-trial with a PaCO2 drop ranging between 23% and 47%. Time to return to baseline after interruption ranged 48–96 hours. In four patients, mechanical events led to ECCO2R premature interruption, despite a decreased in PaCO2. This time window ‘free’ from hypercapnia might allow to propose the concept of ‘CO2 dialysis’.

  • COPD ÀÜ mechanisms
  • critical care
  • non invasive ventilation

http://dx.doi.org/10.1136/thoraxjnl-2020-214744

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    Footnotes

    • Contributors LP performing the experimental trial—writing paper. SN study design, performing experimental trial, writing paper. ED performing the experimental trial. MP performing the experimental trial, revising paper. TT statistical analysis. VMR study design, writing paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Review boards approved the protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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