title: Applying a low-flow CO2 removal device in severe acute hypercapnic respiratory failure.
abstract: A novel and portable extracorporeal CO2-removal device was evaluated to provide additional gas transfer, auxiliary to standard therapy in severe acute hypercapnic respiratory failure. A dual-lumen catheter was inserted percutaneously in five subjects (mean age 55 ± 0.4 years) and, subsequently, connected to the CO2-removal device. The median duration on support was 45 hours (interquartile range 26-156), with a blood flow rate of approximately 500 mL/min. The mean PaCO2 decreased from 95.8 ± 21.9 mmHg to 63.9 ± 19.6 mmHg with the pH improving from 7.11 ± 0.1 to 7.26 ± 0.1 in the initial 4 hours of support. Three subjects were directly weaned from the CO2-removal device and mechanical ventilation, one subject was converted to ECMO and one subject died following withdrawal of support. No systemic bleeding or device complications were observed. Low-flow CO2 removal adjuvant to standard therapy was effective in steadily removing CO2, limiting the progression of acidosis in subjects with severe acute hypercapnic respiratory failure.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands ajay.sharma@maastrichtuniversity.nl.
authors.forename: Ajay S
authors.initials: AS
authors.lastname: Sharma
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Weerwind
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Uli
authors.initials: U
authors.lastname: Strauch
authors.affiliation: Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Arne
authors.initials: A
authors.lastname: van Belle
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
authors.affiliation: Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000097:blood / Q000517:prevention & control*
chemical_list: D002245:Carbon Dioxide
keywords: COPD; acidosis; acute hypercapnic respiratory failure; extracorporeal CO2 removal; low-flow