Extracorporeal removal CO2 using a venovenous, low-flow system (Decapsmart) in a lung transplanted patient: a case report.
BACKGROUND
Primary graft dysfunction (PGD) is a syndrome that may occur after lung transplantation. In some cases of severe PGD, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and surfactant and intravenous prostacyclins are inadequate to achieve adequate gas exchange. The only lifesaving option is to use an extracorporeal membrane oxygenator. The Decapsmart is a new venovenous, low-flow extracorporeal device to removal carbon dioxide (CO(2)). It does not need a specialized staff. Herein we have presented a case report of a patient who underwent single lung transplantation and experienced respiratory failure.


METHODS
On November 2007, a 52-year-old woman underwent a single right lung transplantation, and developed severe PGD in the postoperative period. After institution of conventional treatments, including ventilatory and hemodynamic support, iNO, and prostaglandine E1, we started treatment with Decapsmart to remove CO(2). Hemodynamic and respiratory parameters were assessed at baseline and after 3, 12, 24, and 48 hours.


RESULTS
No adverse events occurred. From baseline to 48 hours, pH values increased and partial pressure of CO(2) reduced. At the same time ventilatory support was reduced, thereby mitigating barotrauma and risk of overdistension.


CONCLUSIONS
The use of Decapsmart may be an important aid for patients with severe respiratory acidosis in association with conventional therapy during the perioperative period after lung transplantation.
Ruberto
F
F
Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Universita' Degli Studi di Roma "La Sapienza," Viale del Policlinico N 188, 00144 Roma, Italia. rube2005@libero.it
Pugliese
F
F
D'Alio
A
A
Perrella
S
S
D'Auria
B
B
Ianni
S
S
Anile
M
M
Venuta
F
F
Coloni
G F
GF
Pietropaoli
P
P
D000527:Alprostadil / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000302:isolation & purification*; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage
D002245:Carbon Dioxide; D009569:Nitric Oxide; D000527:Alprostadil