The Role of the Extracorporeal CO2 Removal in a Patient Who Had a Near-fatal Asthma Attack.

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Sabaz M. S., Kaya B. E., Kamilova N., Balcı Ö. F., Gül F.

24th International Intensive Care Symposium, İstanbul, Türkiye, 5 - 06 Mayıs 2023, cilt.21, ss.140

  • Yayın Türü: Bildiri / Özet Bildiri
  • Cilt numarası: 21
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.140
  • Marmara Üniversitesi Adresli: Evet

Özet

[OP-195]

The Role of the Extracorporeal CO2 Removal in a Patient Who Had a Near-fatal Asthma Attack

Mehmet Süleyman Sabaz1, Batuhan Kaya2, Nuray Kamilova2,

Ömer Faruk Balcı2, Fethi Gül1

1Marmara University Faculty of Medicine, Department of Anesthesiology and

Reanimation, Division of Intensive Care, İstanbul, Turkey

2Marmara University Faculty of Medicine, Department of Anesthesiology and

Reanimation, İstanbul, Turkey

Introduction: Extracorporeal carbon dioxide removal (ECCO2R) is a respiratory support method that solely offers decarboxylation with

minimal blood flow (0.3-1.0 L/min). Here we present the ECCO2R treatment in a patient who was intubated due to hypercarbic respiratory failure after

an asthma attack.

Case: A 18-year-old male patient with a diagnosis of asthma admitted to the emergency room with respiratory distress. He was suffering with persistent wheezing and dyspnea. Physical examination showed decreased auscultation in both lungs. Chest X-ray was normal and the blood gas analysis showed a deep respiratory acidosis (Ph: 6.98, pCO2: 162 mmHg, pO2: 208 mmHg, HCO3: -26.4, BE: -1.6). The patient was intubated and admitted to the intensive care unit (ICU). He was treated with budesonide

+ salbutamol + ipatropiumbromide + theophylline + intravenous steroid and magnesium sulfate during that period. Neuromuscular blocking agent was added to treatment in addition to deep sedation due to ongoing bronchospasm. Hypercapnia and respiratory acidosis was persist despite high mechanical ventilatory support (PEEP: 10 cmH2O, Psupport: 35 cmH2O, respiratory rate: 30, FiO2:%40). The VV-ECCO2R (multi ECCO2R®- Fresenius Medical Care) was started on the 2nd day of hospitalization.

The extracorporeal blood flow was set at 300-350 mL/min, while the sweep gas flow was adjusted to be 3-6 L/min according to the pCO2 value.

Unfractionated heparin was used for systemic anticoagulation. In times

hypercarbia regressed gradually, blood gas parameters improved and

ventilatory supports decreased (Table 1). He was successfully weaned from

the ECCO2R on the 5th day and then extubated. He was discharged to the

ward with nasal oxygen support.

Discussion: Most asthma attacks can be treated but some patients remain

uncontrolled despite adequate therapy. The use of ECCO2R has been shown

for the possibility of earlier extubation after severe asthma attack who

need invasive-mechanical ventilation. In our patient, who was suffering

from life-threathening asthma attack and finally discharged from the ICU,

VV-ECCO2R corrected hypercapnia and acidosis, allowed the reduction of

other supportive measures and the favored the weaning from mechanical

ventilation.

Keywords: ECCO2R, extracorporeal carbon dioxide removal, asthma attack,

hypercapnia