P-244EXTRACORPOREAL LUNG SUPPORT FOR PATIENTS WITH ACUTE EXACERBATED CHRONIC OBSTRUCTIVE PULMONARY DISEASE FAILING NON-INVASIVE VENTILATION: IMPLEMENTATION OF A NOVEL ALGORITHM OF RESPIRATORY THERAPY

Abstract

Objectives: Non‐invasive ventilation (NIV) is the most important therapy option for treating patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD). In case of NIV‐failure, other therapeutic options are necessary to guarantee efficient CO2‐removal. So far, invasive mechanical ventilation (IMV) was predominantly performed. However, invasive ventilation is associated with several complications such as barotrauma, ventilator associated pneumonia (VAP) or prolonged weaning. In this context, the use of extracorporeal lung support (ECLS) for CO2‐removal may be beneficial. Methods: From September 2014 to March 2015, 8 patients treated with awake‐ELCS due to AECOPD and NIV failure were included in the current analysis. The results were compared to a historical population (n = 9), which was treated with IMV. Results: While establishing the ECLS‐program in our institution a respiratory therapy algorithm for the treatment of ECLS‐patients, based on literary data, was developed. Alltogether 8 patients (4 female, mean age 59 ± 13) received awake ECLS therapy due to AECOPD and NIV failure. The historical population consisted of 9 patients (4 female, mean age 60 ± 33) receiving IMV. Patients with awake‐ECLS were mobilized several times daily. Patients performed respiratory therapy by using different devices such as sustained maximal inspiration trainer. Moreover, mucolytic therapy (oscillating positive expiratory pressure (PEP), active cycle of breathing technique (ACBT), aerosol therapy) was performed. Within our population a significantly lower rate of bronchoscopy for mucus removal (P = 0.006, t‐test) and a significantly shorter ICU stay (P= 0.001, t‐test) were observed in comparison to the historical population. Conclusion: ECLS represents a safe and effective alternative to IMV for the treatment of AECOPD and NIV‐failure. Advantages are mainly the possibility of early respiratory therapy, mucolytic therapy and breathing exercises with awake patients. Avoiding IMV reduces the rate of VAP. Different randomized and controlled studies showed a positive effect of early pulmonary rehabilitation on the outcome of patients with AECOPD. Future studies shall examine these aspects in the ECLS population.