{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T22:49:39Z","timestamp":1778885379857,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T00:00:00Z","timestamp":1649980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Experimental Physiology"],"published-print":{"date-parts":[[2022,5]]},"abstract":"New Findings<\/jats:title>\nWhat is the main observation in this case?<\/jats:bold><\/jats:p>\nSeveral studies have reported progressive hypoxaemia once extracorporeal carbon dioxide removal is started in patients with hypercapnic respiratory failure, possibly attributable to an altered respiratory quotient.<\/jats:p><\/jats:list-item>\nWhat insights does it reveal?<\/jats:bold><\/jats:p>\nIn this quality control report, we show that the respiratory quotient exhibits only minimal alteration when extracorporeal carbon dioxide removal is started and assume that the progressive hypoxaemia is attributable to an increase in intrapulmonary shunt.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>Abstract<\/jats:title>The use of extracorporeal carbon dioxide removal (ECCO2<\/jats:sub>R) has been proposed in patients with acute respiratory distress syndrome to achieve lung\u2010protective ventilation and in patients with selective hypercapnic respiratory failure. However, several studies have reported progressive hypoxaemia, as expressed by a need to increase the inspired oxygen fraction (Fi<\/jats:sub>O2<\/jats:sub>) to maintain adequate oxygenation or by a decrease in the ratio of arterial oxygen tension (Pa<\/jats:sub>O2<\/jats:sub>) to Fi<\/jats:sub>O2<\/jats:sub> once ECCO2<\/jats:sub>R is started. We present the case of a patient who was admitted to the intensive care unit for a coronavirus disease 2019 pneumonia and who was intubated because of hypercapnic respiratory insufficiency. Extracorporeal carbon dioxide removal was started, and the patient subsequently developed progressive hypoxaemia. To test whether the hypoxaemia was attributable to the ECCO2<\/jats:sub>R, blood samples were taken in different settings: (1) \u2018no ECCO2<\/jats:sub>R\u2019, blood flow 150\u00a0ml\/min with a ECCO2<\/jats:sub>R gas flow of 0\u00a0L\/min; and (2) \u2018with ECCO2<\/jats:sub>R\u2019, blood flow 400\u00a0ml\/min with gas flow 12 L\/min. We measured Pa<\/jats:sub>O2<\/jats:sub>, alveolar oxygen tension, Pa<\/jats:sub>O2<\/jats:sub>\/Fi<\/jats:sub>O2<\/jats:sub>, alveolar\u2013arterial oxygen tension difference, arterial carbon dioxide tension and the respiratory quotient (RQ) by indirect calorimetry in each setting. The RQ was 0.60 without ECCO2<\/jats:sub>R and 0.57 with ECCO2<\/jats:sub>R. The alveolar oxygen tension was 220.4\u00a0mmHg without ECCO2<\/jats:sub>R and increased to 240.3\u00a0mmHg with ECCO2<\/jats:sub>R, whereas Pa<\/jats:sub>O2<\/jats:sub>\/Fi<\/jats:sub>O2<\/jats:sub> decreased from 177 to 171. Our study showed only a minimal change in RQ when ECCO2<\/jats:sub>R was started. We were the first to measure the RQ directly, before and after the initiation of ECCO2<\/jats:sub>R, in a patient with hypercapnic respiratory failure.<\/jats:p><\/jats:sec>","DOI":"10.1113\/ep090282","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T16:44:49Z","timestamp":1647276289000},"page":"424-428","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of extracorporeal carbon dioxide removal on respiratory quotient measured by indirect calorimetry: Unravelling the mystery"],"prefix":"10.1113","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0034-0614","authenticated-orcid":false,"given":"Idris E.","family":"Ghijselings","sequence":"first","affiliation":[{"name":"Department of Intensive Care University Hospital of Brussels Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brecht","family":"Bockstael","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University Hospital of Brussels Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"De Waele","sequence":"additional","affiliation":[{"name":"Department of Intensive Care University Hospital of Brussels Brussels Belgium"},{"name":"Department of Nutrition University Hospital of Brussels Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7477-600X","authenticated-orcid":false,"given":"Joop","family":"Jonckheer","sequence":"additional","affiliation":[{"name":"Department of Intensive Care University Hospital of Brussels Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010016\u20104452\u2010y"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3233\/CH\u2010201080"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010019\u201005567\u20104"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010016\u20104493\u20102"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010018\u20105409\u20100"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010015\u20104166\u20106"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12980"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/50.8.753"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010016\u20104673\u20100"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9958343"}],"container-title":["Experimental Physiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/EP090282","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1113\/EP090282","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/EP090282","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T09:48:44Z","timestamp":1692870524000},"score":1,"resource":{"primary":{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/10.1113\/EP090282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,15]]},"references-count":10,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1113\/EP090282"],"URL":"https:\/\/doi.org\/10.1113\/ep090282","archive":["Portico"],"relation":{},"ISSN":["0958-0670","1469-445X"],"issn-type":[{"value":"0958-0670","type":"print"},{"value":"1469-445X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,15]]},"assertion":[{"value":"2021-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}