We present three patients with respiratory failure in whom conventional mechanical lung ventilation resulted in unacceptably high levels of carbon dioxide, severe acidosis and high vasopressor requirements. A pumpless arteriovenous extracorporeal carbon dioxide removal device (Novalung) was inserted. Arterial carbon dioxide levels were reduced rapidly with a corresponding increase in pH, reduction in vasopressor requirements and reduction in inspiratory pressures. One patient required the additional use of high frequency oscillatory ventilation. There were no complications associated with use of the device. We conclude that use of extracorporeal carbon dioxide removal devices should be considered at an early stage in the management of respiratory failure refractory to conventional ventilatory techniques.
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