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Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: a proof-of-concept study
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  • Published on:
    Reply to: Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: applying the concept.
    • Lara Pisani, Professor, MD Alma Mater Studiorum – Università di Bologna, Dipartimento di Scienze Mediche e Specialistiche, Respiratory and Critical Care Me
    • Other Contributors:
      • Stefano Nava, Professor; MD
      • Tommaso Tonetti, MD
      • Vito Marco Ranieri, Professor, MD

    To the Editor

    We thank Dr. Bhakta and colleagues for their interest in our article on the use of extracorporeal CO2 removal (ECCO2R) in patients with stable COPD and chronic hypercapnia (1).
    Bhakta et al. pointed out the role of non invasive ventilation (NIV) to treat chronic hypercapnic respiratory failure by improving alveolar ventilation. The Authors additionally argued that, in evaluating the efficacy of ECCO2R in hypercapnic COPD stable patients who have failed NIV therapy, we only concentrated on the hypercapnic rather than the hypoxic aspects, pointing out that in this population symptomatic relief and long-term CO2 reduction cannot occur without improved oxygenation.
    These points of discussion give us the opportunity to better explain the ECCO2R functioning and consequently the methodology of our study.
    ECCO2R refers to an extracorporeal circuit that is able to selectively extract carbon dioxide from blood with little to no effect on oxygenation. Various ECCO2R systems are now available. In addition to PaCO2 baseline level, the ability of different ECCO2R devices to eliminate CO2 is dependent upon two important determinants: 1) the surface area available for gas exchange and 2) the blood flow rate (2). Moreover, the partial pressure gradient of the gas across the membrane can be obtained by using oxygen or air as sweep gas, according to Fick’s law of diffusion. Because in minimally invasive veno-venous ECCO 2 R systems the ratio of catheter...

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    Conflict of Interest:
    None declared.
  • Published on:
    Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: applying the concept.
    • Pradipta Bhakta, Anaesthesiologist and Intensivist Consultant, Department of Anaesthesia and Intensive Care, University Hospital Kerry, Tralee, Kerry, Ireland.

    Title: Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: applying the concept.
    Pradipta Bhakta, Antonio M. Esquinas, Brian O’Brien.
    Authors:
    1. Dr. Pradipta Bhakta (MD, MNAMS, FCAI, EDRA, EDIC)
    Consultant,
    Department of Anaesthesia and Intensive Care,
    University Hospital Kerry, Tralee, Kerry, Ireland.
    Phone: 00353894137596.
    Email: bhaktadr@hotmail.com
    2. Dr. Antonio M. Esquinas (PhD, MD)
    Consultant,
    Department of Intensive Care,
    Hospital Morales Meseguer,
    Murcia, Spain.
    Phone: 0034609321966
    Email: antmesquinas@gmail.com
    3. Dr. Brian O’Brien [FCARCSI, FJFICMI, FCICM (ANZ)]
    Consultant and Chair,
    Department of Anaesthesia and Intensive Care,
    Cork University Hospital, Cork, Ireland.
    Mobile: 00353877931656
    Email: drbobrien@hotmail.com
    Authors and their role:
    1. Dr. Pradipta Bhakta: Was involved analysis of the article, writing and editing the letter.
    2. Dr. Antonio M. Esquinas: Was involved analysis of the article, writing and editing the letter.
    3. Dr. Brian O’Brien: Was involved analysis of the article, writing and editing the letter.
    Corresponding Author: Dr. Pradipta Bhakta,
    Consultant,
    Departm...

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    Conflict of Interest:
    None declared.