Intensive Care Medicine

, Volume 45, Issue 2, pp 255–256 | Cite as

Understanding hypoxemia on ECCO2R: back to the alveolar gas equation

  • Jean-Luc DiehlEmail author
  • Alain Mercat
  • Antonio Pesenti
Understanding the Disease

Extracorporeal CO2 removal (ECCO2R) is a promising technique for ARDS and for severe acute exacerbations of COPD [1]. However, ECCO2R carries its own risk of complications and side effects. Beyond hemorrhagic and thrombotic complications and hemolysis, the occurrence of progressive hypoxemia has been reported in COPD patients treated by ECCO2R, leading to a tracheal intubation rate of 28% in the prospective series from Braune et al. [2]. Obviously, progressive hypoxemia can be explained by pulmonary complications such as evolving infiltrates, even if other factors such as modification of the respiratory quotient have been proposed [2, 3]. Accordingly, we illustrate such a mechanism, intrinsically linked to the ECCO2R technique and not involving any worsening of lung function by itself.

A 76-year-old man was admitted because of a very severe hypercapnic acute exacerbation of a chronic respiratory failure due to non-cystic fibrosis bronchiectasis. Invasive mechanical ventilation...


Funding information

No specific funding has been dedicated to this publication.

Compliance with ethical standards

Conflicts of interest

Jean-Luc Diehl received fees from Xenios and Alung for consulting and lectures. Funding for research purposes: Alung Technologies (EPHEBE study, NCT02586948). Alain Mercat received fees from ALung for lectures. Antonio Pesenti received fees from Xenios and Getinge for consulting and lectures.

Ethical statement

Treatment with ECCO2R was performed as part of a specific registry (Registry on the EXperience of Extracorporeal CO2 Removal in Intensive Care Units, NCT02965079), benefiting from an approval (07 March 2016) from the Ethics Committee of the French Intensive Care Society.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Intensive Care MedicineHôpital Européen Georges PompidouParisFrance
  2. 2.INSERM, UMR_S1140: Innovations Thérapeutiques en Hémostase, Faculté des Sciences Pharmaceutiques et BiologiquesParis Descartes UniversityParisFrance
  3. 3.Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire d’AngersUniversité d’AngersAngersFrance
  4. 4.Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
  5. 5.Department of Anesthesia, Critical Care and Emergency MedicineFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanMilanItaly

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