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

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.