Background: High volume intensive care units with high expertise on respiratory distress syndromes are familiar with extracorporeal CO 2 elimination procedures in regard to their maintenance. In contrast, small intensive care units offer a lack of this experience. So, a novel approach (passive, invasive, without any further specification) plugs this lack of experience.Case Report: A 60 years old male patient in poor health conditions was presented to our small intensive care unit due to shortness of breath in regard to bilateral pneumonia in septic shock. Sedated and intubated, we monitored blood gas analyses and observed pCO 2 problems, raising to 150mmHg with stable pO 2 85mmHg. We used interventional arteriovenous lung assist system iLA (Novalung®, Heilbronn, Germany) and improved respiratory conditions by reduction of pCO 2 to normal levels constantly for 10 days. Using iLA (Novalung®) on our small ICU we healed passively and invasively the patient for discharging on day 15. Conclusion:This case report clearly demonstrates the unspectacular use of the highly effectual passive and invasive CO 2 elimination system iLA, Novalung® (Heilbronn, Germany) even on a small intensive care unit of a hospital for basic and regular care in Germany.