17: Personalized Approach to Respiratory Failure Management: Extra Corporeal CO₂ Removal (ECCO₂R) and HFNC in Complex Kyphoscoliosis with Challenging Airway.

Introduction: Kyphoscoliosis is a complex spinal deformity that presents significant respiratory complications, including restrictive lung disease, hypercapnic respiratory failure, and anticipated difficult airways. The situation becomes even more challenging if the patient has a superimposed chest infection, which requires a careful treatment plan. Methods: This report describes a retrospective case involving a 60-year-old male with advanced kyphoscoliosis, restrictive lung disease, and a history of difficult intubation. He was admitted to the ICU with worsening respiratory failure due to community-acquired pneumonia (CAP). A trial of non-invasive ventilation (NIV) using BiPAP failed due to total dependency and worsening respiratory status. Given the patient’s condition and the anticipated difficult intubation, along with the family’s reluctance for invasive mechanical ventilation and the high possibility of difficult weaning following recovery, a personalized care plan was created to meet the patient’s needs. A combined approach of ECCO₂R therapy alongside high-flow nasal cannula (HFNC) was chosen for managing hypoxic hypercapnic respiratory failure. Results: The combined approach of ECCO₂R and HFNC was effective and well-tolerated. The patient demonstrated a gradual reduction in hypercapnia after starting ECCO₂R, while his hypoxia improved with HFNC. Following treatment for his chest infection, he was successfully weaned off ECCO₂R and subsequently from HFNC, returning to his baseline nighttime BiPAP. This strategy allowed for effective physiotherapy and nutritional support, leading to his stable discharge from the ICU. Conclusion: This case report emphasizes the importance of personalized care plans recognizing that each patient is unique. It highlights that ECCO₂R and HFNC as less invasive alternatives to mechanical ventilation in patients with type II respiratory failure and anticipated airway difficulties.