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- Title
Extracorporeal Carbon Dioxide Removal (ECCO2 R) Complication in Chronic Obstructive Pulmonary Disease (COPD): Bleeding.
- Authors
Uluç, Kamuran; Öngel, Esra Akkütük; Köylü, Nazan İlkaya; Devran, Özkan; Özçelik, Hatice Kutbay
- Abstract
Introduction: Non-invasive ventilation is used in the treatment of severe forms of acute hypercapnic respiratory failure in COPD patients,but it fails in approximately 40% of patients. In these patients,endotracheal intubation should be applied and invasive mechanical ventilation (IMV) should be started. The aim of IMV is to provide adequate gas exchange and to reduce the respiratory workload.Recent studies on the use of extracorporeal carbon dioxide removal (ECCO2 R) system in COPD acute attack to prevent IMV or to improve ventilation parameters by assisting IMV have supported that ECCO2 R R has an effective role in the management of this patient population. Case: A 45-year-old male patient with a diagnosis of COPD is admitted to the emergency department with the complaint of shortness of breath lasting for 10 days. The patient was admitted to the intensive care unit on the 3rd day due to the increase in respiratory distress. The patient, whose type 2 respiratory failure continued during his stay in the intensive care unit, was followed up with BIPAP 7/26 cm H2 O pressure and FiO2 100%. After his general condition deteriorated, he was intubated on the 4th day. ECCO2 R R was attached to the patient on the 2nd day after IMV. Blood flow was adjusted as 300 mL/min, scavenging gas as 10 L/min, and heparin dose as 50 U/kg. The patient was supported with ECCO2 R R for 48 hours. The ECCO2 R R of the patient who had bleeding from the catheter site was terminated. Necessary blood product replacement was done and 0.5 mL of protamine sulfate was given. The patient was hypotensive and although inotropic support was increased,the patient’s vitals did not improve and he died. Discussion: The disadvantage of using low current in the ECCO2 R R application is that the risk of coagulation is very high and complete anticoagulation is required. Complication rates range from 10-44%, with bleeding and thrombosis being the most common. In our patient,we think that the vitals of the patient deteriorated after bleeding and he died.
- Subjects
NONINVASIVE ventilation; CHRONIC obstructive pulmonary disease; CARBON dioxide; PROTAMINES; INTENSIVE care units; BLOOD products
- Publication
Turkish Journal of Intensive Care, 2023, Vol 21, p68
- ISSN
2146-6416
- Publication type
Case Study