Abstract
BackgroundLung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis.This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R).MethodsThis was a prospective pilot study, using the Abylcap® (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h. Adverse events (AE) were recorded prospectively.We included 10 ARDS patients on MV, with PaO2/FiO2 < 150 mmHg, tidal volume ≤ 8 mL/kg with positive end-expiratory pressure ≥ 5 cmH2O, FiO2 titrated to SaO2 88–95%, plateau pressure ≥ 28 cmH2O, and respiratory acidosis (pH <7.25).ResultsAfter 2-h of ECCO2R, 6 patients had a ≥ 20% decrease in PaCO2 (60%); PaCO2 decreased 28.4% (from 58.4 to 48.7 mmHg, p = 0.005), and pH increased (1.59%, p = 0.005). ECCO2R was hemodynamically well tolerated. During the whole period of ECCO2R, 6 patients had an AE (60%); bleeding occurred in 5 patients (50%) and circuit thrombosis in 3 patients (30%), these were judged not to be life threatening.ConclusionsIn ARDS patients, low flow ECCO2R significantly reduced PaCO2 after 2 h, Follow up during the entire ECCO2R period revealed a high incidence of bleeding and circuit thrombosis.Trial registrationhttps://clinicaltrials.gov identifier: NCT01911533, registered 23 July 2013.
Highlights
Lung protective mechanical ventilation (MV) is the corner stone of therapy for Acute Respiratory Distress Syndrome (ARDS)
A significant increase in PaO2/FiO2 was noted, indicating amelioration of ARDS. In this prospective crossover pilot study in patients with moderate or severe ARDS, we found that with stable MV settings, low flow extracorporeal CO2 removal (ECCO2R) resulted in a rapid decrease of arterial carbon dioxide pressure (PaCO2) with almost one-third
An important advantage of this low flow veno-venous ECCO2R treatment is that blood flow (Qb) up to 500 mL/min can be achieved by using a catheter that is used for continuous renal replacement therapy (CRRT), making it a less invasive technique compared with others that are using an arterial catheter or large bore wire-reinforced extracorporeal membrane oxygenation (ECMO) cannulas [22, 23, 27,28,29,30]
Summary
Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. its use may be limited by respiratory acidosis. Lung protective mechanical ventilation (MV), i.e. use of a tidal volume (VT) of 6 mL/kg predicted body weight (PBW) and plateau pressure (PPLAT) lower than 30 cmH2O has been shown to lead to improved outcomes [3,4,5]. Some authors reported the use of ECCO2R in series with continuous renal replacement therapy (CRRT), offering an additional method of correcting acidosis. In these studies only patients who presented with acute kidney injury and ARDS were included [17,18,19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
