HYPERCAPNIC RESPIRATORY FAILURE: THE ROLE OF LUNG DIALYSIS TO CHANGE THE NATURAL HISTORY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Frequent occurrence (2+/year) of severe acute exacerbations of COPD (AECOPD) is associated to a mortality that is higher than those observed in patients with infrequent occurrence (0-1/year). Hypercapnia is the hallmark of severe AECOPD. PaCO2 higher than 52 mmHg is associated to higher mortality. RESPIRATORY DIALYSIS (an artificial lung embedded in a circuit for renal replacement therapy that selectively removes CO2) optimally minimize hypercapnia avoiding need for intubation/tracheostomy in patients with respiratory failure due to AECOPD. We examine the hypothesis that since hypercapnia is the determinant of severe AECOPD, RESPIRATORY DIALYSIS may intervene on the 3 milestones of the natural history of COPD: (1) when hypercapnia occurs in stable patients; (2) when hypercapnia does not respond to NIV in patients with acute respiratory failure; (3) when hypercapnia develops in the pre, intra and post-operative settings of lung transplant. RESPIRATORY DIALYSIS is expected to PREVENT (in stable patients), TREAT (in patients with acute respiratory failure) and MINIMIZE impact (in lung recipients) of severe AECOPD and therefore result in a relevant improvement of outcome. We will develop/test a method to double the CO2 removal rate for a given blood flow.