title: Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation.
abstract: OBJECTIVE
  To evaluate whether extracorporeal carbon dioxide removal by means of a pumpless extracorporeal lung-assist (PECLA) device could be an effective and safe alternative to invasive mechanical ventilation in patients with chronic pulmonary disease and acute hypercapnic ventilatory failure not responding to noninvasive ventilation (NIV).
  
  
  METHODS
  In this multicentre, retrospective study, 21 PECLA patients were compared with respect to survival and procedural outcomes to 21 matched controls with conventional invasive mechanical ventilation. Matching criteria were underlying diagnosis, age, Simplified Acute Physiology Score II and pH at ICU admission.
  
  
  RESULTS
  Of the 21 patients treated with PECLA, 19 (90 %) did not require intubation. Median PaCO(2) levels and pH in arterial blood prior to PECLA were 84.0 mmHg (54.2-131.0) and 7.28 (7.10-7.41), respectively. Within 24 h, median PaCO(2) levels and pH had significantly improved to 52.1 (33.0-70.1; p < 0.001) and 7.44 (7.27-7.56; p < 0.001), respectively. Two major and seven minor bleeding complications related to the device occurred. Further complications were one pseudoaneurysm and one heparin-induced thrombocytopenia type 2. Compared to the matched control group, there was a trend toward a shorter hospital length of stay in the PECLA group (adjusted p = 0.056). There was no group difference in the 28-day (24 % vs. 19 %, adjusted p = 0.845) or 6-month mortality (33 % vs. 33 %).
  
  
  CONCLUSIONS
  In this study the use of extracorporeal carbon dioxide removal allowed avoiding intubation and invasive mechanical ventilation in the majority of patients with acute on chronic respiratory failure not responding to NIV. Compared to conventional invasive ventilation, short- and long-term survivals were similar.
authors: Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. skluge@uke.uni-hamburg.de
authors: Stefan
authors: S
authors: Kluge
authors: Stephan A
authors: SA
authors: Braune
authors: Markus
authors: M
authors: Engel
authors: Axel
authors: A
authors: Nierhaus
authors: Daniel
authors: D
authors: Frings
authors: Henning
authors: H
authors: Ebelt
authors: Alexander
authors: A
authors: Uhrig
authors: Maria
authors: M
authors: Metschke
authors: Karl
authors: K
authors: Wegscheider
authors: Norbert
authors: N
authors: Suttorp
authors: Simone
authors: S
authors: Rousseau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D016022:Case-Control Studies; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide