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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Dyspnea | Research

Control of respiratory drive by extracorporeal CO2 removal in acute exacerbation of COPD breathing on non-invasive NAVA

Authors: Christian Karagiannidis, Stephan Strassmann, Sarah Schwarz, Michaela Merten, Eddy Fan, Jennifer Beck, Christer Sinderby, Wolfram Windisch

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Veno-venous extracorporeal CO2 removal (vv-ECCO2R) and non-invasive neurally adjusted ventilator assist (NIV-NAVA) are two promising techniques which may prevent complications related to prolonged invasive mechanical ventilation in patients with acute exacerbation of COPD.

Methods

A physiological study of the electrical activity of the diaphragm (Edi) response was conducted with varying degrees of extracorporeal CO2 removal to control the respiratory drive in patients with severe acute exacerbation of COPD breathing on NIV-NAVA.

Results

Twenty COPD patients (SAPS II 37 ± 5.6, age 57 ± 9 years) treated with vv-ECCO2R and supported by NIV-NAVA were studied during stepwise weaning of vv-ECCO2R. Based on dyspnea, tolerance, and blood gases, weaning from vv-ECCO2R was successful in 12 and failed in eight patients. Respiratory drive (measured via the Edi) increased to 19 ± 10 μV vs. 56 ± 20 μV in the successful and unsuccessful weaning groups, respectively, resulting in all patients keeping their CO2 and pH values stable. Edi was the best predictor for vv-ECCO2R weaning failure (ROC analysis AUC 0.95), whereas respiratory rate, rapid shallow breathing index, and tidal volume had lower predictive values. Eventually, 19 patients were discharged home, while one patient died. Mortality at 90 days and 180 days was 15 and 25%, respectively.

Conclusions

This study demonstrates for the first time the usefulness of the Edi signal to monitor and guide patients with severe acute exacerbation of COPD on vv-ECCO2R and NIV-NAVA. The Edi during vv-ECCO2R weaning was found to be the best predictor of tolerance to removing vv-ECCO2R.
Appendix
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Literature
1.
Piquilloud L, Tassaux D, Bialais E, Lambermont B, Sottiaux T, Roeseler J, Laterre PF, Jolliet P, Revelly JP. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med. 2012;38(10):1624–31.PubMed
2.
Sinderby C, Beck J, Spahija J, de Marchie M, Lacroix J, Navalesi P, Slutsky AS. Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest. 2007;131(3):711–7.PubMed
3.
Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L. Neural control of mechanical ventilation in respiratory failure. Nat Med. 1999;5(12):1433–6.PubMed
4.
Brander L, Leong-Poi H, Beck J, Brunet F, Hutchison SJ, Slutsky AS, Sinderby C. Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest. 2009;135(3):695–703.PubMed
5.
Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, Brunet F, Sinderby C. Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med. 2008;34(9):1615–23.PubMedPubMedCentral
6.
Doorduin J, Sinderby CA, Beck J, van der Hoeven JG, Heunks LM. Automated patient-ventilator interaction analysis during neurally adjusted non-invasive ventilation and pressure support ventilation in chronic obstructive pulmonary disease. Crit Care. 2014;18(5):550.PubMedPubMedCentral
7.
Cammarota G, Olivieri C, Costa R, Vaschetto R, Colombo D, Turucz E, Longhini F, Della Corte F, Conti G, Navalesi P. Noninvasive ventilation through a helmet in postextubation hypoxemic patients: physiologic comparison between neurally adjusted ventilatory assist and pressure support ventilation. Intensive Care Med. 2011;37(12):1943–50.PubMed
8.
Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, Nardo MD, Belliato M, Grazioli L, Barbaro RP, et al. The extracorporeal life support organization Maastricht Treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med. 2018;198(4):447–51.PubMedPubMedCentral
9.
Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, Muller T, Windisch W. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42(5):889–96.PubMed
10.
Abrams D, Roncon-Albuquerque R Jr, Brodie D. What’s new in extracorporeal carbon dioxide removal for COPD? Intensive Care Med. 2015;41(5):906–8.PubMed
11.
Hilty MP, Riva T, Cottini SR, Kleinert EM, Maggiorini A, Maggiorini M. Low flow veno-venous extracorporeal CO2 removal for acute hypercapnic respiratory failure. Minerva Anestesiol. 2017;83(8):812–23.PubMed
12.
13.
Del Sorbo L, Fan E, Nava S, Ranieri VM. ECCO2R in COPD exacerbation only for the right patients and with the right strategy. Intensive Care Med. 2016;42(11):1830–1.PubMed
14.
Sklar MC, Beloncle F, Katsios CM, Brochard L, Friedrich JO. Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med. 2015;41(10):1752–62.PubMed
15.
Burki NK, Mani RK, Herth FJF, Schmidt W, Teschler H, Bonin F, Becker H, Randerath WJ, Stieglitz S, Hagmeyer L, et al. A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest. 2013;143(3):678–86.PubMed
16.
Crotti S, Lissoni A, Tubiolo D, Azzari S, Tarsia P, Caspani L, Gattinoni L. Artificial lung as an alternative to mechanical ventilation in COPD exacerbation. Eur Respir J. 2012;39(1):212–5.PubMed
17.
Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA. 2000;284(18):2361–7.PubMed
18.
Karagiannidis C, Strassmann S, Callegari J, Kochanek M, Janssens U, Windisch W. Evolving epidemiology of home mechanical ventilation: a rapidly growing challenge for patient care. Dtsch Med Wochenschr. 2018.
19.
Davies MG, Quinnell TG, Oscroft NS, Clutterbuck SP, Shneerson JM, Smith IE. Hospital outcomes and long-term survival after referral to a specialized weaning unit. Br J Anaesth. 2017;118(4):563–9.PubMed
20.
Braune S, Sieweke A, Brettner F, Staudinger T, Joannidis M, Verbrugge S, Frings D, Nierhaus A, Wegscheider K, Kluge S. The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med. 2016;42(9):1437–44.PubMed
21.
Del Sorbo L, Pisani L, Filippini C, Fanelli V, Fasano L, Terragni P, Dell'Amore A, Urbino R, Mascia L, Evangelista A, et al. Extracorporeal CO2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med. 2015;43(1):120–7.PubMed
22.
Boyle AJ, Sklar MC, McNamee JJ, Brodie D, Slutsky AS, Brochard L, McAuley DF, International EN. Extracorporeal carbon dioxide removal for lowering the risk of mechanical ventilation: research questions and clinical potential for the future. Lancet Respir Med. 2018;6(11):874–84.PubMed
23.
Taccone FS, Malfertheiner MV, Ferrari F, Di Nardo M, Swol J, Broman LM, Vercaemst L, Barrett N, Pappalardo F, Belohlavek J, et al. Extracorporeal CO2 removal in critically ill patients: a systematic review. Minerva Anestesiol. 2017;83(7):762–72.PubMed
24.
Morelli A, Del Sorbo L, Pesenti A, Ranieri VM, Fan E. Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure. Intensive Care Med. 2017;43(4):519–30.PubMed
25.
May AG, Sen A, Cove ME, Kellum JA, Federspiel WJ. Extracorporeal CO2 removal by hemodialysis: in vitro model and feasibility. Intensive Care Med Exp. 2017;5(1):20.PubMedPubMedCentral
26.
Karagiannidis C, Lubnow M, Philipp A, Riegger GA, Schmid C, Pfeifer M, Mueller T. Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med. 2010;36(12):2038–44.PubMed
27.
Pisani L, Fasano L, Corcione N, Comellini V, Guerrieri A, Ranieri MV, Nava S. Effects of extracorporeal CO2 removal on inspiratory effort and respiratory pattern in patients who fail weaning from mechanical ventilation. Am J Respir Crit Care Med. 2015;192(11):1392–4.PubMed
28.
Diehl JL, Piquilloud L, Richard JC, Mancebo J, Mercat A. Effects of extracorporeal carbon dioxide removal on work of breathing in patients with chronic obstructive pulmonary disease. Intensive Care Med. 2016;42(5):951–2.PubMed
29.
Luo YM, Moxham J. Measurement of neural respiratory drive in patients with COPD. Respir Physiol Neurobiol. 2005;146(2–3):165–74.PubMed
30.
Liu ZD, Qiu ZH, Tan KX, Xiao SC, Liu MF, Luo YM. Assessment of neural respiratory drive in humans. Zhonghua Jie He He Hu Xi Za Zhi. 2013;36(7):493–6.PubMed
31.
Karagiannidis C, Kampe KA, Sipmann FS, Larsson A, Hedenstierna G, Windisch W, Mueller T. Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations. Crit Care. 2014;18(3):R124.PubMedPubMedCentral
32.
Roze H, Repusseau B, Perrier V, Germain A, Seramondi R, Dewitte A, Fleureau C, Ouattara A. Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist. Br J Anaesth. 2013;111(6):955–60.PubMed
33.
Dres M, Schmidt M, Ferre A, Mayaux J, Similowski T, Demoule A. Diaphragm electromyographic activity as a predictor of weaning failure. Intensive Care Med. 2012;38(12):2017–25.PubMed
34.
Barwing J, Pedroni C, Olgemoller U, Quintel M, Moerer O. Electrical activity of the diaphragm (EAdi) as a monitoring parameter in difficult weaning from respirator: a pilot study. Crit Care. 2013;17(4):R182.PubMedPubMedCentral
35.
Liu L, Liu H, Yang Y, Huang Y, Liu S, Beck J, Slutsky AS, Sinderby C, Qiu H. Neuroventilatory efficiency and extubation readiness in critically ill patients. Crit Care. 2012;16(4):R143.PubMedPubMedCentral
36.
Di Mussi R, Spadaro S, Stripoli T, Volta CA, Trerotoli P, Pierucci P, Staffieri F, Bruno F, Camporota L, Grasso S. High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease. Crit Care. 2018;22(1):180.PubMed
37.
Sinderby C, Beck J, Spahija J, Weinberg J, Grassino A. Voluntary activation of the human diaphragm in health and disease. J Appl Physiol (1985). 1998;85(6):2146–58.
38.
Jolley CJ, Luo YM, Steier J, Reilly C, Seymour J, Lunt A, Ward K, Rafferty GF, Polkey MI, Moxham J. Neural respiratory drive in healthy subjects and in COPD. Eur Respir J. 2009;33(2):289–97.
39.
Allo JC, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA. Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med. 2006;34(12):2997–3004.PubMed
40.
Reilly CC, Jolley CJ, Ward K, MacBean V, Moxham J, Rafferty GF. Neural respiratory drive measured during inspiratory threshold loading and acute hypercapnia in healthy individuals. Exp Physiol. 2013;98(7):1190–8.PubMed
41.
Tuchscherer D, Z'Graggen WJ, Passath C, Takala J, Sinderby C, Brander L. Neurally adjusted ventilatory assist in patients with critical illness-associated polyneuromyopathy. Intensive Care Med. 2011;37(12):1951–61.PubMed
42.
Sinderby C, Spahija J, Beck J, Kaminski D, Yan S, Comtois N, Sliwinski P. Diaphragm activation during exercise in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163(7):1637–41.PubMed
43.
Spahija J, Beck J, de Marchie M, Comtois A, Sinderby C. Closed-loop control of respiratory drive using pressure-support ventilation: target drive ventilation. Am J Respir Crit Care Med. 2005;171(9):1009–14.PubMed
44.
Karagiannidis C, Strassmann S, Brodie D, Ritter P, Larsson A, Borchardt R, Windisch W. Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis. Intensive Care Med Exp. 2017;5(1):34.PubMedPubMedCentral
45.
Karagiannidis C, Strassmann S, Philipp A, Muller T, Windisch W. Veno-venous extracorporeal CO2 removal improves pulmonary hypertension in acute exacerbation of severe COPD. Intensive Care Med. 2015;41(8):1509–10.PubMed
46.
Diehl JL, Mercat A, Pesenti A. Understanding hypoxemia on ECCO2R: back to the alveolar gas equation. Intensive Care Med. 2019;45(2):255–6.PubMed
Metadata
Title
Control of respiratory drive by extracorporeal CO2 removal in acute exacerbation of COPD breathing on non-invasive NAVA
Authors
Christian Karagiannidis
Stephan Strassmann
Sarah Schwarz
Michaela Merten
Eddy Fan
Jennifer Beck
Christer Sinderby
Wolfram Windisch
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2404-y

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