Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation

• Published in: Intensive care medicine 2012-10, Vol.38 (10), p.1632-1639
• Main Authors: Kluge, Stefan, Braune, Stephan A., Engel, Markus, Nierhaus, Axel, Frings, Daniel, Ebelt, Henning, Uhrig, Alexander, Metschke, Maria, Wegscheider, Karl, Suttorp, Norbert, Rousseau, Simone
• Format: Article
• Language: English
• Subjects: Acidosis; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Carbon Dioxide; Carbon dioxide removal; Cardiology; Care and treatment; Case-Control Studies; Chronic obstructive pulmonary disease; Comparative analysis; Critical Care Medicine; Emergency and intensive respiratory care; Emergency Medicine; Extracorporeal Circulation - adverse effects; Extracorporeal Circulation - methods; Female; Health aspects; Humans; Hypercapnia - therapy; Infectious diseases; Intensive; Intensive care; Intensive care medicine; Internal medicine; Intubation; Lung diseases; Male; Medical prognosis; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - therapy; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Respiratory failure; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Retrospective Studies; Sufentanil; Treatment Failure; Ventilators; Young Adult
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-012-2649-2

Purpose 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