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A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a severe complication of coronavirus disease 2019 (COVID-19) infection marked by increased fluid diffusely in alveolar spaces. The management of ARDS can be complicated by mechanical hyperinflation, and thus a mainstay of treatment has included low tidal...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9153857/ https://www.ncbi.nlm.nih.gov/pubmed/35663663 http://dx.doi.org/10.7759/cureus.24645 |
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author | Firzli, Tarek R Sathappan, Sunil Siddiqui, Faisal |
author_facet | Firzli, Tarek R Sathappan, Sunil Siddiqui, Faisal |
author_sort | Firzli, Tarek R |
collection | PubMed |
description | Acute respiratory distress syndrome (ARDS) is a severe complication of coronavirus disease 2019 (COVID-19) infection marked by increased fluid diffusely in alveolar spaces. The management of ARDS can be complicated by mechanical hyperinflation, and thus a mainstay of treatment has included low tidal volume mechanical ventilation. This, however, can lead to ventilation-associated hypercapnia, which may result in respiratory acidosis. COVID-19-associated ARDS (CARDs) has been described in the literature, and guidelines tend to mimic ARDS management. However, the heterogeneous nature of COVID-19 pulmonary disease with respect to dead space, compliance, and shunting could alter guidelines. As low tidal volume remains a cornerstone in CARDS management, hypercapnic acidosis remains a risk. An emerging technology, extracorporeal CO2 removal devices (ECCO2R), has been granted emergency use authorization by the FDA for the management of CARDS. We present a 44-year-old male patient presenting positive for COVID-19. Following admission, the patient's oxygen status continually deteriorated and the patient went into acute respiratory distress, eventually requiring invasive mechanical ventilation. The patient became hypercapnic and acidotic due to low tidal volume ventilation. ECCO2R was used to manage the patient's hypercapnia, resulting in significant amelioration of his partial pressure of carbon dioxide (PCO2) and pH. The patient was eventually transferred to extracorporeal membrane oxygenation (ECMO) certified facility and survived after a prolonged hospital and rehabilitation course. In the management of CARDS patients who require mechanical respiration, there are many unanswered questions as to the appropriate ventilation strategy. Current practice recommends low tidal volume ventilation, carrying, and increased risk of hypercapnic respiratory acidosis as occurred in our patient. We believe that ECCO2R may be an appropriate bridge between low tidal volume ventilation and ECMO to stabilize acid-base disturbances in ventilated patients. |
format | Online Article Text |
id | pubmed-9153857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-91538572022-06-02 A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome Firzli, Tarek R Sathappan, Sunil Siddiqui, Faisal Cureus Emergency Medicine Acute respiratory distress syndrome (ARDS) is a severe complication of coronavirus disease 2019 (COVID-19) infection marked by increased fluid diffusely in alveolar spaces. The management of ARDS can be complicated by mechanical hyperinflation, and thus a mainstay of treatment has included low tidal volume mechanical ventilation. This, however, can lead to ventilation-associated hypercapnia, which may result in respiratory acidosis. COVID-19-associated ARDS (CARDs) has been described in the literature, and guidelines tend to mimic ARDS management. However, the heterogeneous nature of COVID-19 pulmonary disease with respect to dead space, compliance, and shunting could alter guidelines. As low tidal volume remains a cornerstone in CARDS management, hypercapnic acidosis remains a risk. An emerging technology, extracorporeal CO2 removal devices (ECCO2R), has been granted emergency use authorization by the FDA for the management of CARDS. We present a 44-year-old male patient presenting positive for COVID-19. Following admission, the patient's oxygen status continually deteriorated and the patient went into acute respiratory distress, eventually requiring invasive mechanical ventilation. The patient became hypercapnic and acidotic due to low tidal volume ventilation. ECCO2R was used to manage the patient's hypercapnia, resulting in significant amelioration of his partial pressure of carbon dioxide (PCO2) and pH. The patient was eventually transferred to extracorporeal membrane oxygenation (ECMO) certified facility and survived after a prolonged hospital and rehabilitation course. In the management of CARDS patients who require mechanical respiration, there are many unanswered questions as to the appropriate ventilation strategy. Current practice recommends low tidal volume ventilation, carrying, and increased risk of hypercapnic respiratory acidosis as occurred in our patient. We believe that ECCO2R may be an appropriate bridge between low tidal volume ventilation and ECMO to stabilize acid-base disturbances in ventilated patients. Cureus 2022-05-01 /pmc/articles/PMC9153857/ /pubmed/35663663 http://dx.doi.org/10.7759/cureus.24645 Text en Copyright © 2022, Firzli et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Emergency Medicine Firzli, Tarek R Sathappan, Sunil Siddiqui, Faisal A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title | A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title_full | A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title_fullStr | A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title_full_unstemmed | A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title_short | A Case of the Use of Extracorporeal Carbon Dioxide Removal in a Patient With COVID-19 Acute Respiratory Distress Syndrome |
title_sort | case of the use of extracorporeal carbon dioxide removal in a patient with covid-19 acute respiratory distress syndrome |
topic | Emergency Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9153857/ https://www.ncbi.nlm.nih.gov/pubmed/35663663 http://dx.doi.org/10.7759/cureus.24645 |
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