New Publication: “Respiratory Dialysis for Avoidance of Intubation in Acute Exacerbation of COPD”
A new article titled Respiratory Dialysis for Avoidance of Intubation in Acute Exacerbation of COPD was published in the November/December 2013 edition of the ASAIO Journal.
The authors describe two successful cases using the Hemolung RAS to provide minimally invasive extracorporeal carbon dioxide removal (ECCO2R), or Respiratory Dialysis, for the purpose of avoiding intubation in acute exacerbation of chronic obstructive pulmonary disease (COPD). These cases were part of the multicenter study of the Hemolung RAS previously published in the CHEST Journal.
In this report, two patients presented with acute exacerbations of COPD that were unresponsive to non-invasive ventilation. Both patients were quickly stabilized with ECCO2R provided by the Hemolung RAS, resulting in resolution of acidosis, reduction in dyspnea, and return of unassisted spontaneous breathing. Both patients were discharged to home without requiring invasive mechanical ventilation.
The authors concluded the article by writing:
“The Hemolung RAS was easily used and operated at dialysis-like settings to provide the necessary CO2 removal to prevent intubation. There are risks associated with low-flow ECCO2R, which are not insignificant and must be carefully weighed when considering its use. Our experience suggests that these risks, when carefully monitored, are minimal in comparison with the benefits of avoiding invasive mechanical ventilation in patients being treated for an acute exacerbation of COPD.”
Additional details from the article:
A 69-year-old woman with history of COPD presented to Artemis Health Institute with an acute exacerbation after experiencing worsening breathlessness over 6 days. Non-invasive ventilation (NIV) was implemented without significant improvement. After 2 hours of NIV, the patient remained severely acidotic with a PaCO2 of 105 mmHg and pH of 7.193.
Extracorporeal carbon dioxide removal was started with the Hemolung RAS to avoid intubation and invasive mechanical ventilation. After 6 hours of ECCO2R, the patient was fully alert and significantly less breathless with a PaCO2 of 68 mmHg and pH of 7.35. After 48 hours, the patient was weaned from the Hemolung RAS.
“The primary objective of avoiding intubation was achieved” and the patient was discharged to home 7 days after admission.
A 78-year-old man with history of severe COPD and multiple other comorbidities presented to the Thoraxklinik with an acute exacerbation. The patient was dyspneic and sleepy with a PaCO2 of 92 mmHg and pH of 7.24, and was placed on non-invasive ventilation. Treatment with NIV was unsuccessful, and the patient’s living will included a do-not-intubate order. Respiratory Dialysis with the Hemolung RAS was suggested and initiated with the patient’s consent.
Within 4 hours, the patient was stabilized and NIV was discontinued. Hypercapnia and acidosis were relieved within 6 hours with the PaCO2 falling to 55mmHg and pH rising to 7.34. The patient continued to breathe spontaneously, only requiring nocturnal NIV. After 48 hours, the patient was successfully weaned from Hemolung therapy and transferred to the intermediate step down unit. The patient was discharged to home after 10 days.
About the Authors
Dr. Raj Kumar Mani, MD, MRCP (UK), FCCP
Director – Department of Pulmonology, Critical Care, and Sleep Medicine, Saket City Hospital, New Delhi, India
Formerly of Artemis Health Institute, Gurgaon, India
Priv.-Doz. Dr. med. Werner Schmidt
Chief of the Department of Anesthesiology and Intensive Care Medicine
Thoraxklinik, University of Heidelberg
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