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Decapneization as supportive therapy for the treatment of status asthmaticus: a case report

BACKGROUND: Acute severe asthma is a life-threatening medical emergency. Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that can manifest in dangerous levels of hypercapnia and acidosis, with significant mortality and morbidity. Severe respiratory...

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Autores principales: Esposito, Rossella, Esposito, Irene, Imperatore, Francesco, Liguori, Giovanni, Gritti, Fabrizio, Cafora, Chiara, Marsilia, Paolo Francesco, De Cristofaro, Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045444/
https://www.ncbi.nlm.nih.gov/pubmed/33853666
http://dx.doi.org/10.1186/s13256-021-02689-6
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author Esposito, Rossella
Esposito, Irene
Imperatore, Francesco
Liguori, Giovanni
Gritti, Fabrizio
Cafora, Chiara
Marsilia, Paolo Francesco
De Cristofaro, Maria
author_facet Esposito, Rossella
Esposito, Irene
Imperatore, Francesco
Liguori, Giovanni
Gritti, Fabrizio
Cafora, Chiara
Marsilia, Paolo Francesco
De Cristofaro, Maria
author_sort Esposito, Rossella
collection PubMed
description BACKGROUND: Acute severe asthma is a life-threatening medical emergency. Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that can manifest in dangerous levels of hypercapnia and acidosis, with significant mortality and morbidity. Severe respiratory distress can lead to endotracheal intubation followed by mechanical ventilation, which can cause increased air trapping with dynamic hyperinflation, predisposing the lungs to barotraumas. CASE PRESENTATION: The present case report describes the use of the minimally invasive ECCO(2)R ProLUNG(®) (Estor) with protective low-tidal-volume ventilation, in a Caucasian patient with near-fatal asthma and with no response to conventional therapy. CONCLUSIONS: Since hypercarbia rather than hypoxemia is the primary abnormality in status asthmaticus, a rescue therapeutic strategy combining the ECCO(2)R membrane ProLUNG(®) (Estor) with ultra-protective low-tidal-volume ventilation can be successfully applied to limit the risk of severe barotrauma during invasive mechanical ventilation. ECCO(2)R ProLUNG(®) is a partial respiratory support technique that, based on the use of an extracorporeal circuit with a gas-exchange membrane, achieves relevant CO(2) clearance directly from the blood using double-lumen venous-venous vascular access, at blood flow in the range of 0.4–1.0 L/minute.
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spelling pubmed-80454442021-04-15 Decapneization as supportive therapy for the treatment of status asthmaticus: a case report Esposito, Rossella Esposito, Irene Imperatore, Francesco Liguori, Giovanni Gritti, Fabrizio Cafora, Chiara Marsilia, Paolo Francesco De Cristofaro, Maria J Med Case Rep Case Report BACKGROUND: Acute severe asthma is a life-threatening medical emergency. Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that can manifest in dangerous levels of hypercapnia and acidosis, with significant mortality and morbidity. Severe respiratory distress can lead to endotracheal intubation followed by mechanical ventilation, which can cause increased air trapping with dynamic hyperinflation, predisposing the lungs to barotraumas. CASE PRESENTATION: The present case report describes the use of the minimally invasive ECCO(2)R ProLUNG(®) (Estor) with protective low-tidal-volume ventilation, in a Caucasian patient with near-fatal asthma and with no response to conventional therapy. CONCLUSIONS: Since hypercarbia rather than hypoxemia is the primary abnormality in status asthmaticus, a rescue therapeutic strategy combining the ECCO(2)R membrane ProLUNG(®) (Estor) with ultra-protective low-tidal-volume ventilation can be successfully applied to limit the risk of severe barotrauma during invasive mechanical ventilation. ECCO(2)R ProLUNG(®) is a partial respiratory support technique that, based on the use of an extracorporeal circuit with a gas-exchange membrane, achieves relevant CO(2) clearance directly from the blood using double-lumen venous-venous vascular access, at blood flow in the range of 0.4–1.0 L/minute. BioMed Central 2021-04-08 /pmc/articles/PMC8045444/ /pubmed/33853666 http://dx.doi.org/10.1186/s13256-021-02689-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Esposito, Rossella
Esposito, Irene
Imperatore, Francesco
Liguori, Giovanni
Gritti, Fabrizio
Cafora, Chiara
Marsilia, Paolo Francesco
De Cristofaro, Maria
Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title_full Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title_fullStr Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title_full_unstemmed Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title_short Decapneization as supportive therapy for the treatment of status asthmaticus: a case report
title_sort decapneization as supportive therapy for the treatment of status asthmaticus: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045444/
https://www.ncbi.nlm.nih.gov/pubmed/33853666
http://dx.doi.org/10.1186/s13256-021-02689-6
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