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Hypercapnia and extracorporeal carbon dioxide removal (ECCO2R) in the acute respiratory distress syndrome

  • Luis Morales-Quinteros1,2,3*,
  • Jordi Mancebo1
  • Lorenzo Del Sorbo4,5

1Intensive Care Department, Sant Pau University Hospital, 08001 Barcelona, Spain

2Translational Research Laboratory, Institute for Research and Innovation Parc Tauli (I3PT) Universitat Autònoma de Barcelona Sabadell, 08208 Barcelona, Spain

3CIBER Enfermedades Respiratorias, Madrid, Spain

4Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario M5R 2R3, Canada

5Department of Medicine, Division of Respirology, University Health Network, Toronto, Ontario M1E 4E6, Canada

DOI: 10.22514/sv.2022.046 Vol.18,Issue 5,September 2022 pp.33-43

Submitted: 30 January 2022 Accepted: 11 May 2022

Published: 08 September 2022

(This article belongs to the Special Issue New Insights in Acute Respiratory Distress Syndrome)

*Corresponding Author(s): Luis Morales-Quinteros E-mail:


As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have become an attractive option in managing adults with acute respiratory failure. However, evidence to support its use is scarce, and several questions regarding the best way to implement this therapy remain unanswered, which can be associated with severe side effects. In this review, we will present the currently available knowledge on (1) ECCO2R as an adjuvant treatment to invasive mechanical ventilation, (2) the impact of hypercapnia in patients with acute respiratory distress syndrome (ARDS), (3) the pathophysiological rationale and evidence of ECCO2R in patients with ARDS.


Acute respiratory distress syndrome; Extracorporeal carbon dioxide removal; Carbon dioxide; Lung-protective ventilation; Ventilator-associated lung injury

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Luis Morales-Quinteros,Jordi Mancebo,Lorenzo Del Sorbo. Hypercapnia and extracorporeal carbon dioxide removal (ECCO2R) in the acute respiratory distress syndrome. Signa Vitae. 2022. 18(5);33-43.


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