Department of Hemopurification Center, National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China.
Department of Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Clin Hemorheol Microcirc. 2021;78(2):199-207. doi: 10.3233/CH-201080.
Coronavirus disease-19 (COVID-19) is a new type of epidemic pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The population is generally susceptible to COVID-19, which mainly causes lung injury. Some cases may develop severe acute respiratory distress syndrome (ARDS). Currently, ARDS treatment is mainly mechanical ventilation, but mechanical ventilation often causes ventilator-induced lung injury (VILI) accompanied by hypercapnia in 14% of patients. Extracorporeal carbon dioxide removal (ECCO2R) can remove carbon dioxide from the blood of patients with ARDS, correct the respiratory acidosis, reduce the tidal volume and airway pressure, and reduce the incidence of VILI.
Two patients with critical COVID-19 combined with multiple organ failure undertook mechanical ventilation and suffered from hypercapnia. ECCO2R, combined with continuous renal replacement therapy (CRRT), was conducted concomitantly. In both cases (No. 1 and 2), the tidal volume and positive end-expiratory pressure (PEEP) were down-regulated before the treatment and at 1.5 hours, one day, three days, five days, eight days, and ten days after the treatment, together with a noticeable decrease in PCO2 and clear increase in PO2, while FiO2 decreased to approximately 40%. In case No 2, compared with the condition before treatment, the PCO2 decreased significantly with down-regulation in the tidal volume and PEEP and improvement in the pulmonary edema and ARDS after the treatment.
ECCO2R combined with continuous blood purification therapy in patients with COVID-19 who are criti-cally ill and have ARDS and hypercapnia might gain both time and opportunity in the treatment, down-regulate the ventilator parameters, reduce the incidence of VILI and achieve favorable therapeutic outcomes.
新型冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的新型流行性肺炎。人群普遍易感染 COVID-19，主要引起肺损伤。有些病例可能会发展为严重急性呼吸窘迫综合征（ARDS）。目前，ARDS 的治疗主要是机械通气，但机械通气常导致伴有 14%患者发生高碳酸血症的呼吸机诱导性肺损伤（VILI）。体外二氧化碳去除（ECCO2R）可从 ARDS 患者的血液中去除二氧化碳，纠正呼吸性酸中毒，降低潮气量和气道压力，降低 VILI 的发生率。
两名重症 COVID-19 合并多器官功能衰竭患者行机械通气，并发高碳酸血症。同时进行 ECCO2R 与持续肾脏替代治疗（CRRT）。在两种情况下（病例 1 和 2），治疗前和治疗后 1.5 小时、1 天、3 天、5 天、8 天和 10 天，潮气量和呼气末正压（PEEP）均下调，同时 PCO2 明显下降，PO2 明显升高，FiO2 降至约 40%。在病例 2 中，与治疗前相比，PCO2 明显下降，潮气量和 PEEP 下调，肺水肿和 ARDS 改善。
ECCO2R 联合连续血液净化治疗 COVID-19 危重症合并 ARDS 和高碳酸血症的患者，可能在治疗中争取时间和机会，下调呼吸机参数，降低 VILI 的发生率，并获得良好的治疗效果。
