PECLA systems systems have been developed to minimize hypercapnia so as to be able to continue lung-protective mechanical ventilation strategies and to avoid further lung injury in patients with acute respiratory distress syndrome. In 11 case series with 462 patients, the arterial carbon dioxide partial pressure (PaCO2) decreased, concomitantly 191 complications occurred. Because of the lack of comparative studies the question of the efficacy and safety of the PECLA therapy cannot be answered reliably.