{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:04:01Z","timestamp":1784531041188,"version":"3.55.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Artif Organs"],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Background:<\/jats:title>\n \n Hypercapnic respiratory failure is a frequent and life-threatening condition in intensive care. While lung-protective ventilation is essential to limit ventilator-induced lung injury, it may aggravate hypercapnia, particularly in severely ill patients. Low-flow extracorporeal CO\n 2<\/jats:sub>\n removal (ECCO\n 2<\/jats:sub>\n R) has therefore been proposed as an adjunct to facilitate CO\n 2<\/jats:sub>\n clearance and support protective ventilation. When integrated into continuous renal replacement therapy (CRRT) platforms, ECCO\n 2<\/jats:sub>\n R offers a less invasive alternative to high-flow extracorporeal support. However, the effectiveness of CRRT-based ECCO\n 2<\/jats:sub>\n R operated at very low blood flows, particularly under regional citrate anticoagulation, remains insufficiently characterized.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We conducted a retrospective analysis of invasively ventilated ICU patients with severe hypercapnic respiratory failure treated with low-flow ECCO\n 2<\/jats:sub>\n R integrated into a citrate-anticoagulated CRRT system. Arterial blood gas parameters and ventilatory settings were retrospectively extracted at baseline and 2, 12, and 48\u2009h after ECCO\n 2<\/jats:sub>\n R initiation.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In 11 patients, median PaCO\n 2<\/jats:sub>\n decreased from 83.1 to 52.9\u2009mmHg at 48\u2009h, with a corresponding rise in pH from 7.21 to 7.33 (both\n p<\/jats:italic>\n \u2009=\u20090.008). Tidal volume showed early pairwise changes, whereas overall ventilator settings and oxygenation remained unchanged. The system was feasible, required no systemic anticoagulation, and caused no coagulation-related complications.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n In invasively ventilated patients with severe hypercapnic respiratory failure, low-flow ECCO\n 2<\/jats:sub>\n R integrated into citrate-anticoagulated CRRT reduced PaCO\n 2<\/jats:sub>\n and improved acidosis, without significant overall changes in ventilator settings. This first report of exclusive regional citrate anticoagulation in CRRT-based ECCO\n 2<\/jats:sub>\n R demonstrated feasibility and safety without coagulation complications. Despite a blood-flow limit of 200\u2009ml\/min, a statistically significant and clinically detectable reduction in PaCO\n 2<\/jats:sub>\n was achieved.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/03913988261455788","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:30:26Z","timestamp":1783071026000},"page":"544-554","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["First clinical experience with citrate-anticoagulated CVVHD-based low-flow ECCO\n 2<\/sub>\n R in severe hypercapnic respiratory failure"],"prefix":"10.1177","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8793-3587","authenticated-orcid":false,"given":"Frank W.","family":"Kornitzky","sequence":"first","affiliation":[{"name":"Medizinische Klinik mit Schwerpunkt Pneumologie & Beatmungsmedizin, Klinikum W\u00fcrzburg Mitte gGmbH, Standort Missioklinik, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Pfeuffer-Jovi\u0107","sequence":"additional","affiliation":[{"name":"Medizinische Klinik mit Schwerpunkt Pneumologie & Beatmungsmedizin, Klinikum W\u00fcrzburg Mitte gGmbH, Standort Missioklinik, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Stumpner","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr An\u00e4sthesiologie, Intensiv- & Palliativmedizin, Klinikum W\u00fcrzburg Mitte gGmbH, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Held","sequence":"additional","affiliation":[{"name":"Medizinische Klinik mit Schwerpunkt Pneumologie & Beatmungsmedizin, Klinikum W\u00fcrzburg Mitte gGmbH, Standort Missioklinik, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.5.1602"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.10.1180"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200805-722OC"},{"key":"e_1_3_2_5_2","volume-title":"Respiratory failure in adults","author":"Mirabile VS","year":"2025","unstructured":"Mirabile VS, Shebl E, Sankari A, et al. 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StatPearls Treasure Island, FL: StatPearls Publishing, 2025."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-019-0239-0"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14145033"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00063-017-0318-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2025.03.010"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201703-0548ST"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4611-1"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-04927-x"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-019-0244-3"},{"key":"e_1_3_2_14_2","unstructured":"Instructions for Use multiECCO2R Gas Exchanger EU1036 - Rev. 02 2019-08-20. 2020."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4511-4"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-024-01353-8"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.3906\/sag-2012-151"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10405-016-0072-z"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1159\/000525867"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-3921-z"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001803"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-022-01006-8"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-019-0480-4"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003430"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.598379"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc13875"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2038-5"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000607"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-012-2787-6"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05735.x"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-017-0147-0"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2025.108011"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.18618"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0822-z"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1159\/000339789"}],"container-title":["The International Journal of Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261455788","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03913988261455788","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261455788","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:24:41Z","timestamp":1784528681000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03913988261455788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":34,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/03913988261455788"],"URL":"https:\/\/doi.org\/10.1177\/03913988261455788","relation":{},"ISSN":["0391-3988","1724-6040"],"issn-type":[{"value":"0391-3988","type":"print"},{"value":"1724-6040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}