Removing extra CO2 in COPD patients

Curr Respir Care Rep. 2013 Jun 28;2(3):131-138. doi: 10.1007/s13665-013-0057-x. Print 2013.

Abstract

For patients experiencing acute respiratory failure due to a severe exacerbation of chronic obstructive pulmonary disease (COPD), noninvasive positive pressure ventilation has been shown to significantly reduce mortality and hospital length of stay compared to respiratory support with invasive mechanical ventilation. Despite continued improvements in the administration of noninvasive ventilation (NIV), refractory hypercapnia and hypercapnic acidosis continue to prevent its successful use in many patients. Recent advances in extracorporeal gas exchange technology have led to the development of systems designed to be safer and simpler by focusing on the clinical benefits of partial extracorporeal carbon dioxide removal (ECCO2R), as opposed to full cardiopulmonary support. While the use of ECCO2R has been studied in the treatment of acute respiratory distress syndrome (ARDS), its use for acute hypercapnic respiratory during COPD exacerbations has not been evaluated until recently. This review will focus on literature published over the last year on the use of ECCO2R for removing extra CO2 in patients experiencing an acute exacerbation of COPD.

Keywords: Active mixing; Acute exacerbation; Acute hypercapnic respiratory failure; Chronic obstructive pulmonary disease; Extracorporeal carbon dioxide removal; Extracorporeal gas exchange; Extracorporeal membrane oxygenation; Hemolung; Hypercapnia; Hypercarbia; Mechanical ventilation; Noninvasive ventilation; Novalung; Respiratory dialysis.