A case of acute respiratory distress syndrome induced by pneumonia and empyema that was managed using low-flow extracorporeal CO₂ removal

Abstract

A 76-year-old man undergoing follow-up examinations for emphysema was admitted to our hospital with severe hypoxemia. We diagnosed pneumonia and empyema and initiated mechanical ventilation to treat the hypoxemia. However, the patient developed acute respiratory distress syndrome (ARDS), and CO₂ retention was observed; therefore, we set the ventilator in the bilevel positive airway pressure (BIPAP) mode with a plateau pressure of 30 cmH₂O and respiratory rate of 35 /min; however, CO₂ retention and acidosis did not improve (PaCO₂ 58.6 mmHg; pH 7.201). We initiated extracorporeal CO₂ removal (ECCO₂R) and observed improvement in PaCO₂ (38.1 mmHg) and pH (7.396) for 3 hours. The ECCO₂R was stopped on the 6th ICU day and extubation was performed on the 11th ICU day. ECCO₂R seemed to be effective for ARDS cases involving difficulty in management of CO₂.