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

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.