Decapneizzazione extracorporea in pazienti affetti da Broncopneumopatia Cronica Ostruttiva: studio pilota.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity worldwide resulting in a social and economical burden that is substantial and increasing. The major characteristic of COPD is the presence of chronic airflow limitation that is, by definition, largely irreversible. When the unbalance between capacity of the respiratory muscles and increase in respiratory workload becomes severe, acute decompensation occurs and hypercapnia is associated to respiratory acidosis. Non-invasive ventilation (NIV) has been consistently shown to be effective to reduce mortality in patients with acute exacerbations of COPD. In addition, some studies report positive effects of NIV in patients with stable COPD. In both cases, the improvement in outcome has been related to the effectiveness of NIV to remove the excess of carbon dioxide (CO2). Recently, extracorporeal carbon dioxide removal (ECCO2R) technique, that refers to an extracorporeal circuit that is able to selectively extract CO2 from the blood by passing it through a membrane lung, was implemented using a minimally invasive system based on a modified continuous veno-venous hemofiltration device. The main features of this system are a low extracorporeal blood flow and the use of small double-lumen catheters. However, full anticoagulation is required. The present thesis was focused on the efficacy and safety of ECCO2R in three different scenarios and with different purpose: 1. to reduce the need of endotracheal intubation in COPD patients with acute hypercapnic respiratory failure in whom NIV is at risk of failure; 2. to facilitate weaning in mechanically COPD ventilated hypercapnic patients; 3. to evaluate the effects of ECCO2R in terms of arterial blood gas and vital signs modifications in stable COPD patients not responsive to chronic NIV.