Effects of Extracorporeal CO_2 Removal on Inspiratory Effort and Respiratory Pattern in Patients Who Fail Weaning from Mechanical Ventilation

摘要

In patients with acute respiratory failure, severe respiratory acidosis is managed by either invasive or noninvasive ventilation (NIV). Recent data suggest that mechanical ventilation may be supported by extracorporeal CO_2 removal (ECCO2R) to manage the severe respiratory acidosis consequent to superprotective ventilatory strategies in patients with acute respiratory distress syndrome or failure of NIV in patients with acute hypercapnic respiratory failure. In patients who fail weaning from mechanical ventilation, the increase in respiratory muscle effort may quickly lead to respiratory muscle fatigue and pump failure. This prospective physiological pilot investigation aimed to examine the hypothesis that sharing CO_2 extraction between the minute ventilation provided by the respiratory muscles alone and the extracorporeal flow provided by ECCO_2R in the absence of respiratory acidosis may result in a substantial reduction of respiratory muscle effort in patients who fail weaning from mechanical ventilation.