title: Refractory hypercapnia: a simplified technique for extracorporeal CO2 removal (ECCO2R) in the presence of therapeutic limitations.
abstract: Refractory hypercapnia with severe acidosis appeared in a 67-year-old man who presented with lung fibrosis and a left pneumothorax as delayed complications of bleomycin chemotherapy for advanced grade lymphoma. Due to failure of noninvasive ventilation using a high-flow nasal cannula oxygen system, the patient was mechanically ventilated with two ventilators at different settings, after intubation with a double-lumen tube. As he had a poor haematological prognosis, extracorporeal membranous oxygenation was not considered. To remove some amount of carbon dioxide, we used a simplified method based on a veno-venous hemofiltration circuit coupled to a paediatric oxygenator and an air/oxygen blender. The efficacy on carbon dioxide removal was modest, with a percentage of CO2 total extraction ranging from 10.5 to 20.4%, but the system was immediately available, well tolerated and not very expensive.
authors.affiliation: Department of Intensive Care, Cliniques St-Luc, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.forename: X
authors.initials: X
authors.lastname: Wittebole
authors.forename: L M
authors.initials: LM
authors.lastname: Jacquet
authors.forename: P
authors.initials: P
authors.lastname: Hantson
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000097:blood*; D017809:Fatal Outcome; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications / Q000628:therapy
chemical_list: D002245:Carbon Dioxide