Abstract
Chronic hypercapnia is a marker of COPD severity and may be associated with a worst prognosis. The use of chronic NIV, may be beneficial in selected patients, while others fail to improve.
In this feasibility pilot study we assessed the hypothesis that extracorporeal CO2 removal(ECCO2R), may reduce the level of PaCO2 in patients with stable hypercapnic COPD and non responders to chronic NIV.
This was defined as lack of "chronic" changes (<5% improvement in PaCO2 after >1 year of NIV) and lack of "acute" response to NIV (<5% improvement from spontaneous breathing).
Four patients (FEV1= 22,5+4 %pred) underwent a 24 hours trial of ECCO2R in our Respiratory Intensive Care Unit.
Baseline Arterial Blood Gases were (pH=7,37+0.03, PaCO2=74+11 mmHg, PaO2/FiO2= 264+43 and HCO3= 33.5+2.1 mEq/L). After 1-6 and 24 hrs PaCO2 significantly decreased: 62+7 mmHg(1h.), 59+3(6h.), 60+3(24h) p<0.05), together with respiratory rate (23+6 baseline, 21+4;16+4;19+5 at 1,6 and 24 hours, respectively p<0.05 at 6h.).
In one patient the treatment was interrupted prematurely because of a clot in the circuit. None of the patients experienced major complications.
3/4 patients returned to baseline spontaneous breathing level of PaCO2 within the first 24 hours of suspension, while one maintained stable the value within the following 7 days.
In this pilot study we have shown that the application of ECCO2R is safe and feasible in stable severe hypercapnic COPD patients non-respondent to chronic NIV. The device was also able to "acutely" significantly decrease PaCO2.
Further studies are required to assess the long-term effectiveness of ECCO2R and the "response curve" in time of PaCO2.
- Critically ill patients
- Mechanical ventilation - interactions and complications
- Non-invasive ventilation - long-term
- Copyright ©ERS 2015