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Annals of Intensive Care

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Open Access 01-12-2019 | Acute Respiratory Distress-Syndrome | Research

Low-flow CO₂ removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study

Authors: Jens Nentwich, Dominic Wichmann, Stefan Kluge, Simone Lindau, Haitham Mutlak, Stefan John

Published in: Annals of Intensive Care | Issue 1/2019

Abstract

Background

Lung-protective strategies are the cornerstone of mechanical ventilation in critically ill patients with both ARDS and other disorders. Extracorporeal CO₂ removal (ECCO₂R) may enhance lung protection by allowing even further reductions in tidal volumes and is effective in low-flow settings commonly used for renal replacement therapy. In this study, we describe for the first time the effects of a labeled and certified system combining ECCO₂R and renal replacement therapy on pulmonary stress and strain in hypercapnic patients with renal failure.

Methods

Twenty patients were treated with the combined system which incorporates a membrane lung (0.32 m²) in a conventional renal replacement circuit. After changes in blood gases under ECCO₂R were recorded, baseline hypercapnia was reestablished and the impact on ventilation parameters such as tidal volume and driving pressure was recorded.

Results

The system delivered ECCO₂R at rate of 43.4 ± 14.1 ml/min, PaCO₂ decreased from 68.3 ± 11.8 to 61.8 ± 11.5 mmHg (p < 0.05) and pH increased from 7.18 ± 0.09 to 7.22 ± 0.08 (p < 0.05). There was a significant reduction in ventilation requirements with a decrease in tidal volume from 6.2 ± 0.9 to 5.4 ± 1.1 ml/kg PBW (p < 0.05) corresponding to a decrease in plateau pressure from 30.6 ± 4.6 to 27.7 ± 4.1 cmH₂O (p < 0.05) and a decrease in driving pressure from 18.3 ± 4.3 to 15.6 ± 3.9 cmH₂O (p < 0.05), indicating reduced pulmonary stress and strain. No complications related to the procedure were observed.

Conclusions

The investigated low-flow ECCO₂R and renal replacement system can ameliorate respiratory acidosis and decrease ventilation requirements in hypercapnic patients with concomitant renal failure.

Trial registration NCT02590575, registered 10/23/2015.

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Title: Low-flow CO2 removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study
Authors: Jens Nentwich
Dominic Wichmann
Stefan Kluge
Simone Lindau
Haitham Mutlak
Stefan John
Publication date: 01-12-2019
Publisher: Springer International Publishing
Keyword: Acute Respiratory Distress-Syndrome
Published in: Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-019-0480-4

At a glance: The STEP trials

Springer Medicine

Low-flow CO₂ removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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