Utilisation de l’épuration extra-corporelle de dioxyde de carbone dans l’exacerbation de la maladie pulmonaire obstructive chronique: une revue narrative

D'Andrea, Alexia; Banfı, Carlo; Bendjelid, Karim; Giraud, Raphaël

doi:10.1007/s12630-019-01551-0

Cited by 6 publications

(2 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such strategies should be based on the severity of patients, mainly assessed by parameters of dynamic hyperinflation and respiratory acidosis. Based on animal and clinical studies, clinicians should also take into account the performances of the different ECCO 2 R devices and their effects on native lungs respiratory CO 2 elimination [ 22 , 23 ]. Providing such strategies could have important implications for the care of patients and for the design of future RCTs aiming to prove important clinical benefits of ECCO 2 R in very severe AE-COPD patients.…”

Section: Discussionmentioning

confidence: 99%

Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations

Diehl

Piquilloud

Vimpère

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

Background Extracorporeal CO2 removal (ECCO2R) could be a valuable additional modality for invasive mechanical ventilation (IMV) in COPD patients suffering from severe acute exacerbation (AE). We aimed to evaluate in such patients the effects of a low-to-middle extracorporeal blood flow device on both gas exchanges and dynamic hyperinflation, as well as on work of breathing (WOB) during the IMV weaning process. Study design and methods Open prospective interventional study in 12 deeply sedated IMV AE-COPD patients studied before and after ECCO2R initiation. Gas exchange and dynamic hyperinflation were compared after stabilization without and with ECCO2R (Hemolung, Alung, Pittsburgh, USA) combined with a specific adjustment algorithm of the respiratory rate (RR) designed to improve arterial pH. When possible, WOB with and without ECCO2R was measured at the end of the weaning process. Due to study size, results are expressed as median (IQR) and a non-parametric approach was adopted. Results An improvement in PaCO2, from 68 (63; 76) to 49 (46; 55) mmHg, p = 0.0005, and in pH, from 7.25 (7.23; 7.29) to 7.35 (7.32; 7.40), p = 0.0005, was observed after ECCO2R initiation and adjustment of respiratory rate, while intrinsic PEEP and Functional Residual Capacity remained unchanged, from 9.0 (7.0; 10.0) to 8.0 (5.0; 9.0) cmH2O and from 3604 (2631; 4850) to 3338 (2633; 4848) mL, p = 0.1191 and p = 0.3013, respectively. WOB measurements were possible in 5 patients, indicating near-significant higher values after stopping ECCO2R: 11.7 (7.5; 15.0) versus 22.6 (13.9; 34.7) Joules/min., p = 0.0625 and 1.1 (0.8; 1.4) versus 1.5 (0.9; 2.8) Joules/L, p = 0.0625. Three patients died in-ICU. Other patients were successfully hospital-discharged. Conclusions Using a formalized protocol of RR adjustment, ECCO2R permitted to effectively improve pH and diminish PaCO2 at the early phase of IMV in 12 AE-COPD patients, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in WOB was also observed during the weaning process. Trial registration ClinicalTrials.gov: Identifier: NCT02586948.

show abstract

Section: Discussionmentioning

confidence: 99%

Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations

Diehl

Piquilloud

Vimpère

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…ECCO 2 R has been proposed to facilitate ultra-protective ventilation [ 2 , 3 , 4 ] and to promote non-invasive ventilation [ 5 ]. This could be particularly beneficial in patients suffering from respiratory failure, including exacerbations of chronic obstructive pulmonary disease (COPD) [ 6 ], acute respiratory distress syndrome (ARDS) [ 7 ], and patients awaiting lung transplantation [ 8 ]. The amount of CO 2 removed by the extracorporeal support is a crucial determinant of clinical efficacy [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Alkaline Liquid Ventilation of the Membrane Lung for Extracorporeal Carbon Dioxide Removal (ECCO2R): In Vitro Study

et al. 2021

View full text Add to dashboard Cite

Extracorporeal carbon dioxide removal (ECCO2R) is a promising strategy to manage acute respiratory failure. We hypothesized that ECCO2R could be enhanced by ventilating the membrane lung with a sodium hydroxide (NaOH) solution with high CO2 absorbing capacity. A computed mathematical model was implemented to assess NaOH–CO2 interactions. Subsequently, we compared NaOH infusion, named “alkaline liquid ventilation”, to conventional oxygen sweeping flows. We built an extracorporeal circuit with two polypropylene membrane lungs, one to remove CO2 and the other to maintain a constant PCO2 (60 ± 2 mmHg). The circuit was primed with swine blood. Blood flow was 500 mL × min−1. After testing the safety and feasibility of increasing concentrations of aqueous NaOH (up to 100 mmol × L−1), the CO2 removal capacity of sweeping oxygen was compared to that of 100 mmol × L−1 NaOH. We performed six experiments to randomly test four sweep flows (100, 250, 500, 1000 mL × min−1) for each fluid plus 10 L × min−1 oxygen. Alkaline liquid ventilation proved to be feasible and safe. No damages or hemolysis were detected. NaOH showed higher CO2 removal capacity compared to oxygen for flows up to 1 L × min−1. However, the highest CO2 extraction power exerted by NaOH was comparable to that of 10 L × min−1 oxygen. Further studies with dedicated devices are required to exploit potential clinical applications of alkaline liquid ventilation.

show abstract

ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions

Sorbo

Ranieri

Fanelli

2022

Extracorporeal Membrane Oxygenation for Adults

View full text Add to dashboard Cite

Utilisation de l’épuration extra-corporelle de dioxyde de carbone dans l’exacerbation de la maladie pulmonaire obstructive chronique: une revue narrative

Cited by 6 publications

References 42 publications

Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations

Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations

Alkaline Liquid Ventilation of the Membrane Lung for Extracorporeal Carbon Dioxide Removal (ECCO2R): In Vitro Study

ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions

Contact Info

Product

Resources

About