Extracorporeal CO2 Removal in Hypercapnic Patients Who Failed Noninvasive Ventilation and Refuse Endotracheal Intubation: a Case Series
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Pulmonary Disease, Chronic Obstructive
- Sponsor
- University of Roma La Sapienza
- Enrollment
- 35
- Locations
- 1
- Primary Endpoint
- number of patients who avoided endotracheal intubation
- Status
- Completed
- Last Updated
- 9 years ago
Overview
Brief Summary
Noninvasive ventilation represents the standard of care for patients with exacerbation of chronic obstructive pulmonary disease. However, NIV fails in almost 30% of the most severe forms of acute hypercapnic respiratory failure and patients must undergo endotracheal intubation and invasive ventilation to restore adequate gas exchange. Under these circumstances, patients may express a clear intention not to be intubated.The aim of this study is to retrospectively assess efficacy and safety of noninvasive ventilation- plus-extracorporeal Co2 removal in patients who fail NIV and refuse endotracheal intubation.
Detailed Description
During a period of two years (from January 2013 to July 2015) 35 patients with acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease, refused endotracheal intubation after failing NIV and were treated with extracorporeal Co2 removal plus NIV as last resort therapy. The collected data of these patients will be retrospectively matched with data obtained from 35 historical controls who received conventional treatment with endotracheal intubation. The study will retrospectively compare intubation rate, acid base homeostasis, norepinephrine requirements (in the patients who due to clinical conditions were under norepinephrine before starting extracorporeal Co2 removal ) and coagulation parameters.
Investigators
Andrea Morelli
MD. Associate professor
University of Roma La Sapienza
Eligibility Criteria
Inclusion Criteria
- •exacerbation of chronic obstructive pulmonary disease
- •failure of non invasive ventilation
- •expression of a clear intention not to be intubated
Exclusion Criteria
- •alterations in mental status which do not allow to express a clear intention not to be intubated
- •contraindications to anticoagulation
Outcomes
Primary Outcomes
number of patients who avoided endotracheal intubation
Time Frame: 60 days
Secondary Outcomes
- Gas exchange homeostasis(96 hrs)
- Norepinephrine requirements(30 days)
- coagulation(30 days)
- Day 28 mortality(28 days)
- intra hospital mortality(180 days)