title: Near-fatal pediatric asthma managed with pumpless arteriovenous carbon dioxide removal.
abstract: OBJECTIVE
  To describe the use of pumpless arteriovenous carbon dioxide removal in support of four pediatric patients with near-fatal asthma.
  
  
  METHODS
  Report of four cases.
  
  
  METHODS
  Tertiary care university pediatric intensive care unit.
  
  
  METHODS
  Four pediatric patients, ages 4, 10, 12, and 13, were intubated and initially managed with positive pressure ventilation for severe respiratory failure. Despite pharmacologic therapy with inhaled beta-agonists, inhaled anticholinergics, systemic corticosteroids, and intravenous magnesium, marked progressive hypercapnia and acidosis rapidly developed requiring high levels of positive pressure ventilation.
  
  
  METHODS
  Application of pumpless arteriovenous carbon dioxide removal (AVCO2R) via percutaneous femoral cannulation.
  
  
  RESULTS
  Arterial or mixed venous carbon dioxide partial pressure (PCO2) and pH were measured before and at intervals following initiation of AVCO2R. Before cannulation, PCO2 was elevated to 100, 108, 90, and 186 mm Hg in the four patients, with corresponding pH of 7.07, 6.96, 7.09, and 6.80, respectively. Pco2 levels were reduced to more acceptable levels (37-57 mm Hg) within 2-4 hrs of initiation of AVCO2R, with corresponding improvements in pH despite reductions in ventilatory frequency and tidal volumes to safe levels. Duration of support ranged from 18 hrs to 5 days during resolution of bronchospasm. No red blood cell or platelet transfusions were required, and no complications resulted from AVCO2R or from mechanical ventilation. All patients were discharged from the hospital without sequelae.
  
  
  CONCLUSIONS
  Percutaneous cannulation with a simplified pumpless extracorporeal circuit is capable of removing sufficient carbon dioxide to allow application of a protective ventilatory strategy in severe hypercapnic pediatric respiratory failure. The procedure was safely applied without complications in four pediatric patients as young as 4 yrs of age.
authors: Extracorporeal Life Support Program, Critical Care Medicine Division, Deparlment of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA. sconrad@lsuhsc.edu
authors: Steven A
authors: SA
authors: Conrad
authors: Rebecca
authors: R
authors: Green
authors: L Keith
authors: LK
authors: Scott
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications*; D002245:Carbon Dioxide; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment; D015199:Extracorporeal Membrane Oxygenation; D006440:Hemofiltration; D006801:Humans; D006935:Hypercapnia / Q000209:etiology* / Q000628:therapy*; D008297:Male
chemical_list: D002245:Carbon Dioxide