• Andrea Moscatelli, Giancarlo Ottonello, Laura Nahum, Elisabetta Lampugnani, Franco Puncuh, Alessandro Simonini, Miriam Tumolo, and Pietro Tuo.
• Istituto Giannina Gaslini, Department of Anesthesia and Intensive Care, Neonatal and Pediatric Intensive Care Unit, Genoa, Italy.
• Pediatr Crit Care Me. 2010 Jan 1;11(1):e8-12.

ObjectiveTo report the successful management of end-stage hypercapnic respiratory failure through the association of noninvasive mechanical ventilation and a novel automated device (Decapsmart) of low-flow veno-venous extracorporeal CO2 removal.DesignCase report.SettingsPediatric intensive care unit at a tertiary care children's hospital.PatientA pediatric patient affected by bronchiolitis obliterans with refractory hypercapnic respiratory failure. The patient received successful lung transplantation after respiratory support with noninvasive mechanical ventilation and a novel automated device of low-flow veno-venous extracorporeal CO2 removal.InterventionsTreatment of end-stage hypercapnic respiratory failure with the association of noninvasive ventilation and low-flow veno-venous extracorporeal CO2 removal as a bridge to lung transplantation.Measurements And Main ResultsRespiratory support controlling hypercapnia, limiting volutrauma, barotraumas, and preventing the incidence of ventilator-associated pneumonia/lung colonization.ConclusionNoninvasive mechanical ventilation and Decapsmart have proven efficacious in managing refractory hypercapnic respiratory failure in a pediatric patient awaiting lung transplantation.

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