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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2013

Open Access 01-05-2013 | Original

Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS

The prospective randomized Xtravent-study

Authors: Thomas Bein, Steffen Weber-Carstens, Anton Goldmann, Thomas Müller, Thomas Staudinger, Jörg Brederlau, Ralf Muellenbach, Rolf Dembinski, Bernhard M. Graf, Marlene Wewalka, Alois Philipp, Klaus-Dieter Wernecke, Matthias Lubnow, Arthur S. Slutsky

Published in: Intensive Care Medicine | Issue 5/2013

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Abstract

Background

Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V T) strategy (V T ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS.

Methods

Seventy-nine patients were enrolled after a ‘stabilization period’ (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V T ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (≈6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality.

Results

Ventilation with very low V T’s was easy to implement with extracorporeal CO2-removal. VFD’s within 60 days were not different between the study group (33.2 ± 20) and the control group (29.2 ± 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 ≤150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 ± 12.8) compared to control (28.2 ± 16.4, p = 0.033). The mortality rate was low (16.5 %) and did not differ between groups.

Conclusions

The use of very low V T combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a ‘normal’ lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928).
Appendix
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Metadata
Title
Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS
The prospective randomized Xtravent-study
Authors
Thomas Bein
Steffen Weber-Carstens
Anton Goldmann
Thomas Müller
Thomas Staudinger
Jörg Brederlau
Ralf Muellenbach
Rolf Dembinski
Bernhard M. Graf
Marlene Wewalka
Alois Philipp
Klaus-Dieter Wernecke
Matthias Lubnow
Arthur S. Slutsky
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2787-6

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