Volume 17 Supplement 2
Effect of extracorporeal CO2 removal on respiratory rate in spontaneously breathing patients with chronic obstructive pulmonary disease exacerbation
© Spinelli et al.; licensee BioMed Central Ltd. 2013
Published: 19 March 2013
During severe exacerbation of chronic obstructive pulmonary disease (COPD) tachypnea, as a consequence of respiratory acidosis, and airflow limitation, due to small airway obstruction, lead to lung hyperinflation, respiratory distress and gas exchange impairment. Invasive mechanical ventilation could worsen lung hyperinflation and produce a vicious circle. We investigated whether increasing extracorporeal carbon dioxide removal (ECCO2 Cl) could reduce the respiratory rate (RR), so prolonging time for lung emptying and allowing resolution of hyperinflation.
In all patients RR decreased with the increase of extracorporeal CO2 removal and a negative correlation was found between RR and ECCO2 Cl/total VCO2 (r 2 = 0.42, P < 0.01). In all patients we were able to obtain a reduction of RR below 15 (28 ± 4 vs. 8 ± 4, RR at low gas flow vs. RR at maximal gas flow, P < 0.001). The selected maximal gas flow was variable between different patients (6.7 ± 2 l/minute), corresponding to different levels of ECCO2 Cl/total VCO2 (83 ± 17%, range 53 to 100%) and RR response (8 ± 4, range 5 to 14).
In patients with COPD exacerbation, who failed noninvasive ventilation, VV-ECMO allows one to maintain spontaneous breathing. Titration of extracorporeal CO2 removal leads to control RR. This approach could interrupt the vicious circle of dynamic hyperinflation and allow the deflation of lung parenchyma.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.