Physiological Assessment of ECCO2R on the Work of Breathing in Exacerbations of COPD

Nicholas A Barrett; Francesco Murgolo; Salvatore Grasso; Eirini Kostakou; Nicholas Hart; Patrick Murphy; Abdel Douiri; Luigi Camporota

doi:10.1080/15412555.2024.2436169

Physiological Assessment of ECCO₂R on the Work of Breathing in Exacerbations of COPD

Nicholas A Barrett, Francesco Murgolo, Salvatore Grasso, Eirini Kostakou, Nicholas Hart, Patrick Murphy, Abdel Douiri, Luigi Camporota

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	2436169
Journal	COPD: Journal of Chronic Obstructive Pulmonary Disease
Volume	21
Issue number	1
DOIs	https://doi.org/10.1080/15412555.2024.2436169
Publication status	Published - Dec 2024

Keywords

Humans
Pulmonary Disease, Chronic Obstructive/physiopathology
Male
Aged
Noninvasive Ventilation
Female
Carbon Dioxide
Work of Breathing
Middle Aged
Disease Progression
Acidosis, Respiratory/physiopathology
Electromyography
Electric Impedance
Esophagus/physiopathology

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10.1080/15412555.2024.2436169

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@article{7c6992c9528b459a88a4318005258c6f,

title = "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.",

keywords = "Humans, Pulmonary Disease, Chronic Obstructive/physiopathology, Male, Aged, Noninvasive Ventilation, Female, Carbon Dioxide, Work of Breathing, Middle Aged, Disease Progression, Acidosis, Respiratory/physiopathology, Electromyography, Electric Impedance, Esophagus/physiopathology",

author = "Barrett, {Nicholas A} and Francesco Murgolo and Salvatore Grasso and Eirini Kostakou and Nicholas Hart and Patrick Murphy and Abdel Douiri and Luigi Camporota",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.",

year = "2024",

month = dec,

doi = "10.1080/15412555.2024.2436169",

language = "English",

volume = "21",

journal = "COPD: Journal of Chronic Obstructive Pulmonary Disease ",

issn = "1541-2555",

publisher = "Taylor and Francis",

number = "1",

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TY - JOUR

T1 - Physiological Assessment of ECCO2R on the Work of Breathing in Exacerbations of COPD

AU - Barrett, Nicholas A

AU - Murgolo, Francesco

AU - Grasso, Salvatore

AU - Kostakou, Eirini

AU - Hart, Nicholas

AU - Murphy, Patrick

AU - Douiri, Abdel

AU - Camporota, Luigi

PY - 2024/12

Y1 - 2024/12

N2 - 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.

AB - 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.

KW - Humans

KW - Pulmonary Disease, Chronic Obstructive/physiopathology

KW - Male

KW - Aged

KW - Noninvasive Ventilation

KW - Female

KW - Carbon Dioxide

KW - Work of Breathing

KW - Middle Aged

KW - Disease Progression

KW - Acidosis, Respiratory/physiopathology

KW - Electromyography

KW - Electric Impedance

KW - Esophagus/physiopathology

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U2 - 10.1080/15412555.2024.2436169

DO - 10.1080/15412555.2024.2436169

M3 - Article

C2 - 39639560

AN - SCOPUS:85211582523

SN - 1541-2555

VL - 21

JO - COPD: Journal of Chronic Obstructive Pulmonary Disease

JF - COPD: Journal of Chronic Obstructive Pulmonary Disease

IS - 1

M1 - 2436169

ER -

Physiological Assessment of ECCO₂R on the Work of Breathing in Exacerbations of COPD

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