Minimal-flow ECCOR in patients needing CRRT does not facilitate lung-protective ventilation.

J Artif Organs 2019 Mar 3;22(1):68-76. Epub 2018 Oct 3.

Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical Center, Göttingen, Germany Robert-Koch-Str. 40, 37099, Göttingen, Germany.

Extracorporeal CO removal (ECCOR) is intended to facilitate lung protective ventilation in patients with hypercarbia. The combination of continuous renal replacement therapy (CRRT) and minimal-flow ECCOR offers a promising concept for patients in need of both. We hypothecated that this system is able to remove enough CO to facilitate lung protective ventilation in mechanically ventilated patients. In 11 ventilated patients with acute renal failure who received either pre- or postdilution CRRT, minimal-flow ECCOR was added to the circuit. During 6 h of combined therapy, CO removal and its effect on facilitation of lung-protective mechanical ventilation were assessed. Ventilatory settings were kept in assisted or pressure-controlled mode allowing spontaneous breathing. With minimal-flow ECCOR significant decreases in minute ventilation, tidal volume and paCO were found after one and three but not after 6 h of therapy. Nevertheless, no significant reduction in applied force was found at any time during combined therapy. CO removal was 20.73 ml CO/min and comparable between pre- and postdilution CRRT. Minimal-flow ECCOR in combination with CRRT is sufficient to reduce surrogates for lung-protective mechanical ventilation but was not sufficient to significantly reduce force applied to the lung. Causative might be the absolute amount of CO removal of only about 10% of resting CO production in an adult as we found. The benefit of applying minimal flow ECCOR in an uncontrolled setting of mechanical ventilation might be limited.

Download full-text PDF

Source
http://link.springer.com/10.1007/s10047-018-1068-8
Publisher Site
http://dx.doi.org/10.1007/s10047-018-1068-8DOI Listing
March 2019

Publication Analysis

Top Keywords

minimal-flow eccor
20
mechanical ventilation
12
crrt minimal-flow
12
sufficient reduce
8
therapy removal
8
pre- postdilution
8
postdilution crrt
8
protective ventilation
8
lung protective
8
lung-protective mechanical
8
combined therapy
8
ventilated patients
8
facilitate lung
8
ventilation
7
eccor
6
patients
5
crrt
5
minimal-flow
5
force time
4
facilitation lung-protective
4

Similar Publications

Feasibility and safety of low-flow extracorporeal CO removal managed with a renal replacement platform to enhance lung-protective ventilation of patients with mild-to-moderate ARDS.

Crit Care 2018 05 10;22(1):122. Epub 2018 May 10.

Sorbonne Université, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, F-75013, Paris, France.

Background: Extracorporeal carbon-dioxide removal (ECCOR) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (P) (< 30 cmHO), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCOR managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS).

Methods: Twenty patients with mild (n = 8) or moderate (n = 12) ARDS were included. Read More

View Article and Full-Text PDF
May 2018

Safety and Efficacy of Combined Extracorporeal CO2 Removal and Renal Replacement Therapy in Patients With Acute Respiratory Distress Syndrome and Acute Kidney Injury: The Pulmonary and Renal Support in Acute Respiratory Distress Syndrome Study.

Crit Care Med 2015 Dec;43(12):2570-81

Service de Réanimation, Hôpital Européen Marseille, Marseille, France.

Objective: To assess the safety and efficacy of combining extracorporeal CO2 removal with continuous renal replacement therapy in patients presenting with acute respiratory distress syndrome and acute kidney injury.

Design: Prospective human observational study.

Settings: Patients received volume-controlled mechanical ventilation according to the acute respiratory distress syndrome net protocol. Read More

View Article and Full-Text PDF
December 2015

Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome.

Crit Care 2016 Feb 10;20:36. Epub 2016 Feb 10.

Service de Réanimation Médicale, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.

Background: Mechanical ventilation with a tidal volume (VT) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (Pplat) lower than 30 cmH2O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low VT combined with extracorporeal carbon dioxide removal (ECCO2R).

Methods: In fifteen patients with moderate ARDS, VT was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure--(Pplat) between 23 and 25 cmH2O. Read More

View Article and Full-Text PDF
February 2016

Feasibility and safety of extracorporeal CO removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study.

Intensive Care Med 2019 05 21;45(5):592-600. Epub 2019 Feb 21.

Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Via Massarenti, 9, 40138, Bologna, Italy.

Purpose: We assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCOR) to facilitate ultra-protective ventilation (V 4 mL/kg and P ≤ 25 cmHO) in patients with moderate acute respiratory distress syndrome (ARDS).

Methods: Prospective multicenter international phase 2 study. Primary endpoint was the proportion of patients achieving ultra-protective ventilation with PaCO not increasing more than 20% from baseline, and arterial pH > 7. Read More

View Article and Full-Text PDF
May 2019