Low flow extracorporeal CO2 removal in ARDS patients: a prospective short-term crossover pilot study

BMC Anesthesiology

Research Article

Filip De Somer¹  Harlinde Peperstraete²  Carl Roosens²  Pieter Depuydt³  Eric Hoste⁴  Sunny Eloot⁵ 

[1] Ghent University, Ghent, Belgium;Department of Cardiac Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium;Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium;Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium;Ghent University, Ghent, Belgium;Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium;Ghent University, Ghent, Belgium;Research Foundation-Flanders (FWO), Brussels, Belgium;Renal Division, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium;Ghent University, Ghent, Belgium;

关键词: Acute respiratory distress syndrome;    Lung protective mechanical ventilation;    Extracorporeal carbon dioxide removal;    Plateau pressure;    Driving pressure;   

DOI  :  10.1186/s12871-017-0445-9

 received in 2017-09-27, accepted in 2017-11-12,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017