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Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.
J Extra Corpor Technol. 2017 06; 49(2):112-114.JE

Abstract

Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO2R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO2R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

Authors+Show Affiliations

Divisions of Critical Care Medicine and Pulmonary and Sleep Medicine, Department of Internal Medicine, McGovern Medical School, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Divisions of Critical Care Medicine and Pulmonary and Sleep Medicine, Department of Internal Medicine, McGovern Medical School, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Department of Thoracic and Cardiovascular Surgery, McGovern Medical School, Houston, Texas. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.Department of Thoracic and Cardiovascular Surgery, McGovern Medical School, Houston, Texas. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas. Department of Thoracic and Cardiovascular Surgery, McGovern Medical School, Houston, Texas.Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28638160

Citation

Akkanti, Bindu, et al. "Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome." The Journal of Extra-corporeal Technology, vol. 49, no. 2, 2017, pp. 112-114.
Akkanti B, Rajagopal K, Patel KP, et al. Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome. J Extra Corpor Technol. 2017;49(2):112-114.
Akkanti, B., Rajagopal, K., Patel, K. P., Aravind, S., Nunez-Centanu, E., Hussain, R., Shabari, F. R., Hofstetter, W. L., Vaporciyan, A. A., Banjac, I. S., Kar, B., Gregoric, I. D., & Loyalka, P. (2017). Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome. The Journal of Extra-corporeal Technology, 49(2), 112-114.
Akkanti B, et al. Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome. J Extra Corpor Technol. 2017;49(2):112-114. PubMed PMID: 28638160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome. AU - Akkanti,Bindu, AU - Rajagopal,Keshava, AU - Patel,Kirti P, AU - Aravind,Sangeeta, AU - Nunez-Centanu,Emmanuel, AU - Hussain,Rahat, AU - Shabari,Farshad Raissi, AU - Hofstetter,Wayne L, AU - Vaporciyan,Ara A, AU - Banjac,Igor S, AU - Kar,Biswajit, AU - Gregoric,Igor D, AU - Loyalka,Pranav, PY - 2016/11/10/received PY - 2017/02/27/accepted PY - 2017/6/23/entrez PY - 2017/6/24/pubmed PY - 2018/3/30/medline KW - acute respiratory distress syndrome KW - extracorporeal carbon dioxide removal (ECCO2R) KW - hemo-lung KW - low flow SP - 112 EP - 114 JF - The journal of extra-corporeal technology JO - J Extra Corpor Technol VL - 49 IS - 2 N2 - Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO2R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO2R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO. SN - 0022-1058 UR - https://www.unboundmedicine.com/medline/citation/28638160/Low_Flow_Extracorporeal_Carbon_Dioxide_Removal_Using_the_Hemolung_Respiratory_Dialysis_System®_to_Facilitate_Lung_Protective_Mechanical_Ventilation_in_Acute_Respiratory_Distress_Syndrome_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28638160/ DB - PRIME DP - Unbound Medicine ER -