Am. J. Respir. Crit. Care Med., Vol 149, No. 6, 06 1994, 1557-1562.
Extracorporeal carbon dioxide removal technique improves oxygenation without causing overinflation
F Brunet, JP Mira, M Belghith, M Monchi, B Renaud, L Fierobe, I Hamy, JF Dhainaut and J Dall'ava-Santucci
Intensive Care Unit, Cochin-Port-Royal University Hospital, Paris, France.
Extracorporeal CO2 removal combined with low frequency positive pressure
ventilation (ECCO2R-LFPPV) improves gas exchange and decreases peak
pressures, respiratory rates, and tidal volumes in animals and in humans.
Recent evidence suggests that pulmonary barotrauma results from lung
overinflation rather than from high pressures. This study was to test the
hypothesis whether ECCO2R-LFPPV could improve gas exchange without causing
lung overinflation, despite the use of higher levels of PEEP, when compared
with conventional mechanical ventilation. Eleven patients with severe adult
respiratory distress syndrome (ARDS) who failed to respond to different
modes of mechanical ventilation were treated with ECCO2R-LFPPV. Risk of
pulmonary barotrauma was evaluated by static pressure-volume (P-V) curves
and dynamic changes in volumes monitored by respiratory inductive
plethysmography (Respitrace). ECCO2R- LFPPV PaO2/FIO2 increased from 79 +/-
21 to 207 +/- 108 (p = 0.003). Risk of barotrauma, as shown by the shape of
the P-V curve, was present in all patients receiving mechanical ventilation
even though most of them were treated with permissive hypoventilation. By
contrast, no evidence of persistent lung overinflation could be detected by
either static P-V curves or dynamic measurements in nine of 11 patients who
were treated by ECCO2R-LFPPV. The two remaining patients had severe airway
obstruction because of bleeding, and they remained ventilated with
persistent risk of barotrauma. We conclude that ECCO2R-LFPPV improves gas
exchange without causing lung overinflation in a majority of patients with
ARDS.
