Noninvasive ventilation and low-flow veno-venous extracorporeal carbon dioxide removal as a bridge to lung transplantation in a child with refractory hypercapnic respiratory failure due to bronchiolitis obliterans*

Moscatelli, Andrea; Ottonello, Giancarlo; Nahum, L. H.; Lampugnani, Elisabetta; Puncuh, Franco; Simonini, Alessandro; Tumolo, Miriam; Tuo, Pietro

doi:10.1097/pcc.0b013e3181b0123b

Cited by 19 publications

(8 citation statements)

References 19 publications

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“…The impact of lung alveoli recruitment on PVRs has to be taken in close consideration in LTx candidates, since irreversible PH and tricuspid regurgitation can indicate combined heart-lung transplantation. [16][17][18] Cardiac function was assessed as completely normal after LTx, confirming our impression of a functional problem instead of a structural one (e.g., endocarditis, cardiomyopathy). [5] LCH recurrence in the transplanted organ has not been reported in children, making LTx a true opportunity of increased survival for such patients.…”

Section: Discussionsupporting

confidence: 58%

“…A better clearance of secretions through the tracheotomy tube, in conjunction with PPV at resting settings, allowed a significant improvement of the echocardiographic signs of PH and right heart failure. The impact of lung alveoli recruitment on PVRs has to be taken in close consideration in LTx candidates, since irreversible PH and tricuspid regurgitation can indicate combined heart–lung transplantation . Cardiac function was assessed as completely normal after LTx, confirming our impression of a functional problem instead of a structural one (e.g., endocarditis, cardiomyopathy) .…”

Section: Discussionmentioning

confidence: 74%

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Long-Term Extracorporeal Membrane Oxygenation as Bridging Strategies to Lung Transplantation in Rapidly Devastating Isolated Langerhans Cell Histiocytosis

Sacco

Moscatelli

Conte

et al. 2016

Pediatr Blood Cancer

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Isolated pulmonary involvement in pediatric Langerhans cell histiocytosis (LCH) is extremely rare. While the multisystem-LCH course varies from spontaneous remission to rapid deterioration with lethal outcome, single system involvement is generally associated with favorable prognosis. A child with isolated pulmonary LCH had an extremely rapid progression leading to respiratory failure, despite treatment with prednisone and vinblastine. Since lung hyperinflation and cystic degeneration contraindicated conventional mechanical ventilation, extracorporeal membrane oxygenation (ECMO) was chosen for 50 days as a bridge to lung transplantation. The mechanisms involved in disease progression and the usefulness of long-term ECMO are discussed.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 74%

Long-Term Extracorporeal Membrane Oxygenation as Bridging Strategies to Lung Transplantation in Rapidly Devastating Isolated Langerhans Cell Histiocytosis

Sacco

Moscatelli

Conte

et al. 2016

Pediatr Blood Cancer

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“…-Via T. Caruto, 9-84131 Salerno, Italy) 16,40 and Hemolung (Alung Technologies Pittsburgh, PA) 15 are pump-driven veno-venous systems for PECCO 2 R. Numerous studies showed their effectiveness in reducing CO 2 levels and correcting respiratory acidosis. -Via T. Caruto, 9-84131 Salerno, Italy) 16,40 and Hemolung (Alung Technologies Pittsburgh, PA) 15 are pump-driven veno-venous systems for PECCO 2 R. Numerous studies showed their effectiveness in reducing CO 2 levels and correcting respiratory acidosis.…”

Section: Discussionmentioning

confidence: 99%

Partial Extracorporeal Carbon Dioxide Removal Using a Standard Continuous Renal Replacement Therapy Device

et al. 2014

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To test the feasibility, safety, and efficacy of partial extracorporeal CO2 removal (PECCO2R) using a standard continuous renal replacement (CRRT) device with a pediatric oxygenation membrane introduced into the circuit in a serial manner. In this retrospective single-center study, we have studied mechanically ventilated patients with persistent significant respiratory acidosis and acute renal failure requiring ongoing CRRT. Sixteen patients were treated with our PECCO2R device. PaCO2 and arterial pH were measured before as well as at 6 and 12 hours after PECCO2R implementation. Hemodynamic parameters were continuously monitored. Our PECCO2R system was efficient to significantly reduce PaCO2 and increase arterial pH. The median PaCO2 before treatment was 77 mm Hg (59-112) with a median reduction of 24 mm Hg after 6 hours and 30 mm Hg after 12 hours (31% and 39%, respectively). The median pH increase was 0.16 at 6 hours and 0.23 at 12 hours. Partial extracorporeal CO2 removal treatment had no effect on oxygenation. No complication was observed. Our PECCO2R approach based on the simple introduction of a pediatric extracorporeal membrane oxygenation membrane into the circuit of a standard CRRT device is easy to implement, safe, and efficient to improve respiratory acidosis.

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“…Consequently, smaller membrane lungs can be used (0.3 to 1.35 m 2 ) with lower flow rates (<500 ml.minute -1 ) than conventional ECCOR [33], resulting in similar anticoagulation requirements to continuous venovenous hemodialysis [46]. The Decap has been successfully used in adults and children [9,47,48]. …”

Section: Venovenous Carbon Dioxide Removalmentioning

confidence: 99%

Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future

et al. 2012

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Acute respiratory distress syndrome (ARDS) has a substantial mortality rate and annually affects more than 140,000 people in the USA alone. Standard management includes lung protective ventilation but this impairs carbon dioxide clearance and may lead to right heart dysfunction or increased intracranial pressure. Extracorporeal carbon dioxide removal has the potential to optimize lung protective ventilation by uncoupling oxygenation and carbon dioxide clearance. The aim of this article is to review the carbon dioxide removal strategies that are likely to be widely available in the near future. Relevant published literature was identified using PubMed and Medline searches. Queries were performed by using the search terms ECCOR, AVCO2R, VVCO2R, respiratory dialysis, and by combining carbon dioxide removal and ARDS. The only search limitation imposed was English language. Additional articles were identified from reference lists in the studies that were reviewed. Several novel strategies to achieve carbon dioxide removal were identified, some of which are already commercially available whereas others are in advanced stages of development.

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Noninvasive ventilation and low-flow veno-venous extracorporeal carbon dioxide removal as a bridge to lung transplantation in a child with refractory hypercapnic respiratory failure due to bronchiolitis obliterans*

Abstract: Noninvasive mechanical ventilation and Decapsmart have proven efficacious in managing refractory hypercapnic respiratory failure in a pediatric patient awaiting lung transplantation.

Cited by 19 publications

References 19 publications

Long-Term Extracorporeal Membrane Oxygenation as Bridging Strategies to Lung Transplantation in Rapidly Devastating Isolated Langerhans Cell Histiocytosis

Long-Term Extracorporeal Membrane Oxygenation as Bridging Strategies to Lung Transplantation in Rapidly Devastating Isolated Langerhans Cell Histiocytosis

Partial Extracorporeal Carbon Dioxide Removal Using a Standard Continuous Renal Replacement Therapy Device

Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future

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