Decapneization as supportive therapy for the treatment of status asthmaticus: a case report

Rossella Esposito,Paolo Francesco Marsilia,Francesco Imperatore,Chiara Cafora,Irene Esposito,Maria De Cristofaro,Fabrizio Gritti,Giovanni Liguori

doi:10.1186/s13256-021-02689-6

Rossella Esposito, Paolo Francesco Marsilia + Show 6 more

Open Access

https://doi.org/10.1186/s13256-021-02689-6

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Abstract

BackgroundAcute severe asthma is a life-threatening medical emergency. Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that can manifest in dangerous levels of hypercapnia and acidosis, with significant mortality and morbidity. Severe respiratory distress can lead to endotracheal intubation followed by mechanical ventilation, which can cause increased air trapping with dynamic hyperinflation, predisposing the lungs to barotraumas.Case presentationThe present case report describes the use of the minimally invasive ECCO2R ProLUNG® (Estor) with protective low-tidal-volume ventilation, in a Caucasian patient with near-fatal asthma and with no response to conventional therapy.ConclusionsSince hypercarbia rather than hypoxemia is the primary abnormality in status asthmaticus, a rescue therapeutic strategy combining the ECCO2R membrane ProLUNG® (Estor) with ultra-protective low-tidal-volume ventilation can be successfully applied to limit the risk of severe barotrauma during invasive mechanical ventilation. ECCO2R ProLUNG® is a partial respiratory support technique that, based on the use of an extracorporeal circuit with a gas-exchange membrane, achieves relevant CO2 clearance directly from the blood using double-lumen venous-venous vascular access, at blood flow in the range of 0.4–1.0 L/minute.

Highlights

Acute severe asthma is a life-threatening medical emergency
Since hypercarbia rather than hypoxemia is the primary abnormality in status asthmaticus, a rescue therapeutic strategy combining the ECCO2R membrane P roLUNG® (Estor) with ultra-protective low-tidal-volume ventilation can be successfully applied to limit the risk of severe barotrauma during invasive mechanical ventilation. ECCO2R ProLUNG® is a partial respiratory support technique that, based on the use of an extracorporeal circuit with a gas-exchange membrane, achieves relevant CO2 clearance directly from the blood using double-lumen venousvenous vascular access, at blood flow in the range of 0.4–1.0 L/minute
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation [1]. It is defined by a history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation. [2] 3 Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that lead to increased work of breathing

Summary

Conclusions

Since hypercarbia rather than hypoxemia is the primary abnormality in status asthmaticus, a rescue therapeutic strategy combining the ECCO2R membrane P roLUNG® (Estor) with ultra-protective low-tidal-volume ventilation can be successfully applied to limit the risk of severe barotrauma during invasive mechanical ventilation. ECCO2R ProLUNG® is a partial respiratory support technique that, based on the use of an extracorporeal circuit with a gas-exchange membrane, achieves relevant CO2 clearance directly from the blood using double-lumen venousvenous vascular access, at blood flow in the range of 0.4–1.0 L/minute.

Findings

Background

Discussion and conclusions