Abstract
Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. This, however, may be associated with worsening hypoxemia, due to several mechanisms, such as gravitational and reabsorption atelectasis, due to a decrease in mean airway pressure and a critically low ventilation-perfusion ratio, respectively. In addition, an imbalance between alveolar and artificial lung partial pressures of nitrogen may accelerate the process. Finally, the decrease in the respiratory quotient, leading to unrecognized alveolar hypoxia and monotonous low plateau pressures preventing critical opening, may contribute to hypoxemia.
Highlights
Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome
In a recent multicenter study, Fanelli et al [1] tested the feasibility of the ultra-protective strategy in combination with extracorporeal carbon dioxide removal (ECCO2R) in 15 patients with moderate acute respiratory distress syndrome (ARDS)
If the artificial lung is ventilated with a fraction of inspired oxygen (FiO2) greater than that used for the natural lung, the partial pressure of nitrogen in the blood perfusing the natural lung is lower than that in the alveoli [7]
Summary
Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. The capability to remove some of the metabolically produced CO2 with artificial lungs using a low extracorporeal blood flow (
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