What every intensivist should know about extracorporeal CO₂ removal in ARDS
• ECCO₂R enables ultraprotective ventilation by safely reducing tidal volume and driving pressure in ARDS. • Appropriate patient selection based on respiratory mechanics, hypercapnia, and ventilatory inefficiency is essential. • Integration of ECCO₂R requires protocolised monitoring across ventilatory, hemodynamic, renal, and hematologic domains. • ECCO₂R should be considered after lung-protective strategies, including prone positioning and PEEP titration, are exhausted. • ECCO₂R is not a substitute for ECMO; its role in ARDS is to enable ultraprotective ventilation.
Authors
- Manuel Garay-Fernández (ORCID: https://orcid.org/0000-0002-3249-6501)
- Henry Mauricio Parada-Gereda (ORCID: https://orcid.org/0009-0008-9749-2596)
- Luis Alexander Peña-López (ORCID: https://orcid.org/0000-0001-5789-690X)
- Gonzalo Ramírez-Guerrero
- Guillermo Ortiz-Ruiz
- David Ballesteros-Castro
Institutions
- University of Cauca (CO)
- Universidad El Bosque (CO)
- International Renal Research Institute of Vicenza (IT)
- Hospital Universitario Infantil San José (CO)
- Fundación Universitaria Sanitas (CO)
Publication Details
- Journal
- Journal of Critical Care
- Published
- 2026-02-16
- DOI
- https://doi.org/10.1016/j.jcrc.2026.155475
- Primary Topic
- Respiratory Support and Mechanisms
- Type
- article
- Field-Weighted Citation Impact
- 0.00