Extracorporeal CO2 removal in stable severe hypercapnic COPD patients non-responding to noninvasive ventilation (NIV): A pilot study

Abstract

Chronic hypercapnia is a marker of COPD severity and may be associated with a worst prognosis. The use of NIV, may be beneficial in selected patients, while others fail to improve. In this feasibility pilot study we assessed the hypothesis that extracorporeal CO 2 removal(ECCO 2 R), may reduce the level of PaCO 2 in patients with stable hypercapnic COPD and non responders to NIV. This was defined as lack of chronic changes ( 2 after >1 year of NIV) and lack of acute to NIV ( Four patients (FEV 1 = 22,5+4 %pred) underwent a 24 hours trial of ECCO 2 R in our Respiratory Intensive Care Unit. Baseline Arterial Blood Gases were (pH=7,37+0.03, PaCO2=74+11 mmHg, PaO 2 /FiO 2 = 264+43 and HCO 3 = 33.5+2.1 mEq/L). After 1-6 and 24 hrs PaCO 2 significantly decreased: 62+7 mmHg(1h.), 59+3(6h.), 60+3(24h) p In one patient the treatment was interrupted prematurely because of a clot in the circuit. None of the patients experienced major complications. 3/4 patients returned to baseline spontaneous breathing level of PaCO2 within the first 24 hours of suspension, while one maintained stable the value within the following 7 days. In this pilot study we have shown that the application of ECCO 2 R is safe and feasible in stable severe hypercapnic COPD patients non-respondent to NIV. The device was also able to acutely significantly decrease PaCO 2 . Further studies are required to assess the long-term effectiveness of ECCO 2 R and the response curve in time of PaCO 2 .