title: Rescue therapy with a pumpless extracorporeal lung assist device in a patient with acute interstitial lung disease and severe refractory hypercapnia.
abstract: Idiopathic interstitial pneumonia frequently causes severe pulmonary restriction that in turn makes mechanical ventilation difficult. We report the case of a 44-year-old woman who developed a refractory severe hypercapnic respiratory failure (P(aCO(2)) 281 mm Hg, pH  6.77) despite mechanical ventilation with high inspiratory pressure and PEEP. A pumpless extracorporeal lung assist device, Novalung, was used as rescue therapy for carbon dioxide removal, enabling lung-protective ventilation and normalization of life-threatening acidosis. Open lung biopsy  revealed an idiopathic interstitial pneumonia with histological features of a nonspecific interstitial pneumonia. Corticosteroid therapy led to progressive improvement of pulmonary function, soon permitting cessation of mechanical ventilation and extracorporeal therapy. The patient was discharged  from the intensive care unit after 20 days. This case demonstrates the successful use of pumpless extracorporeal lung assist as an alternative device to pump-driven extracorporeal membrane oxygenation in severe hypercapnic respiratory failure secondary to nonspecific interstitial pneumonia.
authors.affiliation: Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany. m.petzoldt@uke.de
authors.forename: Martin
authors.initials: M
authors.lastname: Petzoldt
authors.forename: Stephan
authors.initials: S
authors.lastname: Braune
authors.forename: Iris
authors.initials: I
authors.lastname: Bittmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D000328:Adult; D001706:Biopsy; D002245:Carbon Dioxide / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D054988:Idiopathic Interstitial Pneumonias / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D008168:Lung / Q000378:metabolism / Q000473:pathology; D010107:Oxygenators, Membrane; D011175:Positive-Pressure Respiration / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide