COPD (Dec 2024)
Physiological Assessment of ECCO2R on the Work of Breathing in Exacerbations of COPD
Abstract
Rationale The impact of extracorporeal carbon dioxide removal (ECCO2R) on work of breathing and aeration in exacerbations of chronic obstructive pulmonary disease (AECOPD) is poorly understood.Objectives The study explores the impact of non-invasive ventilation (NIV) and ECCO2R on respiratory drive, effort and distribution of ventilation in AECOPD.Methods Patients enrolled in a randomised controlled study of the addition of ECCO2R to NIV compared with NIV underwent oesophageal pressure measurement, electrical impedance tomography and parasternal electromyography.Measurements and main results 18 patients were enrolled, nine in each arm. Of these, eight in the NIV arm and seven in the ECCO2R arm underwent physiological assessment. Patients randomised to ECCO2R, had a period of NIV combined with ECCO2R and, after removal of NIV, a period of ECCO2R alone. The removal of NIV whilst remaining on ECCO2R resulted in a respiratory acidosis (pH 7.34 (7.31–7.34) vs. 7.31 (7.31–7.34), p < 0.0001), increased work of breathing (7.43 (6.08–10.19) vs. 11.1 (8.11–15.15) J/min, p < 0.0001) and increased neural drive (884.4 (684.7–967.3) vs. 1321.1 (903.3–1575.3) AU, p = 0.0005). On day 1, the work of breathing was lower in the NIV than the ECCO2R group (4.38 (2.76–7.27) vs. 8.03 (4.8–15.94) J/min, p < 0.0001), minute ventilation was higher (15.54 (13.14–18.48) vs. 12.24 (8.51–13.9) L/min, p < 0.0001) and neural drive was the same (1,163.8 (1,085.5–1,325.5) vs. 1,093.8 (885.7–1,258.7) AU, p = 0.5556).Conclusions The combination of NIV and ECCO2R results in lower work of breathing and improved neuro-ventilatory coupling. NIV fully supports ventilation early whilst ECCO2R improves neuro-ventilatory coupling and work of breathing over time.Trial registration Clinicaltrials.gov; NCT02086084; registered 1 December 2015; https://clinicaltrials.gov/study/NCT02086084?cond=copd&term=ecco2r&rank=4
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