title: Low-flow venovenous CO₂ removal in association with lung protective ventilation strategy in patients who develop severe progressive respiratory acidosis after lung transplantation.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) might occur after lung transplantation. In some severe cases, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and intravenous prostacyclins are not sufficient to provide an adequate gas exchange. The aim of our study was to evaluate the use of a lung protective ventilation strategy associated with a low-flow venovenous CO2 removal treatment to reduce ventilator-associated injury in patients that develop severe PGD after lung transplantation.
  
  
  METHODS
  From January 2009 to January 2011, 3 patients developed PGD within 24 hours after lung transplantation. In addition to conventional medical treatment, including hemodynamic support, iNO and prostaglandin E1 (PGE1), we initiated a ventilatory protective strategy associated with low-flow venovenous CO2 removal treatment (LFVVECCO2R). Hemodynamic and respiratory parameters were assessed at baseline as well as after 3, 12, 24, and 48 hours.
  
  
  RESULTS
  No adverse events were registered. Despite decreased baseline elevated pulmonary positive pressures, application of a protective ventilation strategy with LFVVECCO2R reduced PaCO2 and pulmonary infiltrates as well as increased pH values and PaO2/FiO2 ratios. Every patient showed simultaneous improvement of clinical and hemodynamic conditions. They were weaned from mechanical ventilation and extubated after 24 hours after the use of the low-flow venovenous CO2 removal device.
  
  
  CONCLUSIONS
  The use of LFVVECCO2R together with a protective lung ventilation strategy during the perioperative period of lung transplantation may be a valid clinical strategy for patients with PGD and severe respiratory acidosis occured despite adequate mechanical ventilation.
authors.affiliation: Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, "Sapienza" University of Rome, Policilinico Umberto I, Rome, Italy. Electronic address: rube2005@libero.it.
authors.forename: F
authors.initials: F
authors.lastname: Ruberto
authors.forename: B
authors.initials: B
authors.lastname: Bergantino
authors.forename: M C
authors.initials: MC
authors.lastname: Testa
authors.forename: C
authors.initials: C
authors.lastname: D'Arena
authors.forename: V
authors.initials: V
authors.lastname: Zullino
authors.forename: P
authors.initials: P
authors.lastname: Congi
authors.forename: S G
authors.initials: SG
authors.lastname: Paglialunga
authors.forename: D
authors.initials: D
authors.lastname: Diso
authors.forename: F
authors.initials: F
authors.lastname: Venuta
authors.forename: F
authors.initials: F
authors.lastname: Pugliese
mesh_terms: D000138:Acidosis / Q000209:etiology*; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide