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Extracorporeal CO 2 removal and renal replacement therapy in acute severe respiratory failure in COVID‐19 pneumonia: Case report
Author(s) -
Gacitúa Ignacio,
Frías Alondra,
Sanhueza María E.,
Bustamante Sergio,
Cornejo Rodrigo,
Salas Andrea,
Guajardo Ximena,
Torres Katherine,
Figueroa Canales Enzo,
Tobar Eduardo,
Navarro Rocío,
Romero Carlos
Publication year - 2021
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12980
Subject(s) - medicine , extracorporeal membrane oxygenation , ards , hypoxemia , respiratory failure , mechanical ventilation , intensive care medicine , renal replacement therapy , pneumonia , anesthesia , covid-19 , context (archaeology) , lung , paleontology , disease , infectious disease (medical specialty) , biology
The COVID‐19 pandemic significates an enormous number of patients with pneumonia that get complicated with severe acute respiratory distress syndrome (ARDS), some of them with refractory hypercapnia and hypoxemia that need mechanical ventilation (MV). Those patients who are not candidate to extracorporeal membrane oxygenation (ECMO), the extracorporeal removal of CO 2 (ECCO 2 R) can allow ultra protective MV to limit the transpulmonary pressures and avoid ventilatory induced lung injury (VILI). We report a first case of prolonged ECCO 2 R support in 38 year male with severe COVID‐19 pneumonia refractory to conventional support. He was admitted tachypneic and oxygen saturation 71% without supplementary oxygen. The patient's clinical condition worsens with severe respiratory failure, increasing the oxygen requirement and initiating MV in the prone position. After 21 days of protective MV, PaCO 2 rise to 96.8 mmHg, making it necessary to connect to an ECCO 2 R system coupled continuous veno‐venous hemodialysis (CVVHD). However, due to the lack of availability of equipment in the context of the pandemic, a pediatric gas exchange membrane adapted to CVVHD allowed to maintain the removal of CO 2 until completing 27 days, being finally disconnected from the system without complications and with a satisfactory evolution.