Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations
Diehl, Jean-Luc (Paris Descartes University)
Piquilloud, Lise (University Hospital and University of Lausanne)
Vimpere, D. (Hôpital Européen Georges Pompidou)
Aissaoui, N. (Hôpital Européen Georges Pompidou)
Guerot, E. (Hôpital Européen Georges Pompidou)
Augy, J.L. (Hôpital Européen Georges Pompidou)
Pierrot, M. (University Hospital of Angers)
Hourton, D. (Hôpital Européen Georges Pompidou)
Arnoux, A. (Hôpital Européen Georges Pompidou)
Richard, C. (Hôpital de Bicètre)
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Mercat, Alain (University Hospital of Angers)
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Extracorporeal CO removal (ECCOR) 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. Open prospective interventional study in 12 deeply sedated IMV AE-COPD patients studied before and after ECCOR initiation. Gas exchange and dynamic hyperinflation were compared after stabilization without and with ECCOR (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 ECCOR 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. An improvement in PaCO, 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 ECCOR 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) cmHO 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 ECCOR: 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. Using a formalized protocol of RR adjustment, ECCOR permitted to effectively improve pH and diminish PaCO 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Alveolar ventilation ; COPD acute exacerbation ; Extracorporeal carbon dioxide removal ; Invasive mechanical ventilation ; Work of breathing
Published in:	Annals of Intensive Care, Vol. 10 Núm. 1 (january 2020) , p. 126, ISSN 2110-5820

DOI: 10.1186/s13613-020-00743-y
PMID: 32990836

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