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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2015 June;54(2):103-10
Extracorporeal CO2 removal for refractory hypercapnia in the event of acute respiratory failure
Vianello A., Arcaro G., Gallan F., Battistella L., Iovino S., Pavan A., Rinaldo C., Peditto P., Marchi M. R.
Respiratory Pathophysiology and Intensive Care Unit, Padua University Hospital, Padua, Italy
Mechanical ventilation (MV) is often considered an indispensable life-sustaining intervention in the event of hypercapnic acute respiratory failure (ARF). Although non-invasive ventilation (NIV), which may improve gas exchange and ultimately avoid the need for intubation and invasive mechanical ventilation (IMV), has been shown to be an effective treatment for ARF in many clinical situations, its failure rate remains high. Extracorporeal CO2 removal (ECCO2R) is increasingly being used to manage patients with refractory severe hypercapnic ARF to avoid IMV and its detrimental adverse effects. Although more studies are necessary to better understand the implications of using ECCO2R in this context, preliminary data from the literature support the view that its utilization is feasible and effective in some severe forms of refractory ARF in which the primary problem is CO2 retention. ECCO2-R can, in particular, be effective in reducing dynamic hyperinflation and in preventing the burdensome complications linked to IMV in patients with acute COPD exacerbation and act as a bridge to lung transplantation in candidates on waiting lists who develop hypercapnia and/or respiratory acidosis.