Erschienen in:
01.06.2009 | Brief Report
Hypercapnia in late-phase ALI/ARDS: providing spontaneous breathing using pumpless extracorporeal lung assist
verfasst von:
Steffen Weber-Carstens, Sven Bercker, Matthias Hommel, Maria Deja, Martin MacGuill, Christiane Dreykluft, Udo Kaisers
Erschienen in:
Intensive Care Medicine
|
Ausgabe 6/2009
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Abstract
Objective
The fibroproliferative phase of late ALI/ARDS as described by Hudson and Hough (Clin Chest Med 27:671–677,
2006) is associated with pronounced reductions in pulmonary compliance and an accompanying hypercapnia complicating low tidal volume mechanical ventilation. We report the effects of extracorporeal CO
2 removal by means of a novel pumpless extracorporeal lung assist (p-ECLA) on tidal volumes, airway pressures, breathing patterns and sedation management in pneumonia patients during late-phase ARDS.
Design
Retrospective analysis.
Setting
Fourteen-bed university hospital ICU.
Patients
Ten consecutive late-phase ALI/ARDS patients with low pulmonary compliance, and severe hypercapnia.
Intervention
Gas exchange, tidal volumes, airway pressures, breathing patterns and sedation requirements before (baseline) and after (2–4 days) initiation of treatment with p-ECLA were analysed. Patients were ventilated in a pressure-controlled mode with PEEP adjusted to pre-defined oxygenation goals.
Measurements and main results
Median reduction in pCO2 was 50% following institution of p-ECLA. Extracorporeal CO2 removal enabled significant reduction in tidal volumes (to below 4 ml/kg predicted body weight) and inspiratory plateau pressures [30 (28.5/32.3) cmH2O, median 25, 75% percentiles]. Normalization of pCO2 levels permitted significant reduction in the dosages of analgesics and sedatives. The proportion of assisted spontaneous breathing increased within 24 h of instituting p-ECLA.
Conclusion
Elimination of CO2 by p-ECLA therapy allowed reduction of ventilator-induced shear stress through ventilation with tidal volumes below 4 ml/kg predicted body weight in pneumonia patients with severely impaired pulmonary compliance during late-phase ARDS. p-ECLA treatment supported control of breathing pattern while sedation requirements were reduced and facilitated the implementation of assisted spontaneous breathing.