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

Stefan Kluge| Stephan A. Braune| Markus Engel| Axel Nierhaus| Daniel Frings| Henning Ebelt| Alexander Uhrig| Maria Metschke| Karl Wegscheider| Norbert Suttorp| Simone Rousseau
Original
Volume 38, Issue 10 / October , 2012

Pages 1632 - 1639

Abstract

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 PaCO2 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 PaCO2 levels and pH had significantly improved to 52.1 (33.0–70.1; p < 0.001) and 7.44 (7.27–7.56; p < 0.001), respectively. Two major and seven minor bleeding complications related to the device occurred. Further complications were one pseudoaneurysm and one heparin-induced thrombocytopenia type 2. Compared to the matched control group, there was a trend toward a shorter hospital length of stay in the PECLA group (adjusted p = 0.056). There was no group difference in the 28-day (24 % vs. 19 %, adjusted p = 0.845) or 6-month mortality (33 % vs. 33 %).

Conclusions

In this study the use of extracorporeal carbon dioxide removal allowed avoiding intubation and invasive mechanical ventilation in the majority of patients with acute on chronic respiratory failure not responding to NIV. Compared to conventional invasive ventilation, short- and long-term survivals were similar.

Keywords

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