Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study

被引：180

作者：

Combes, Alain ^{[1
,2
]}

Fanelli, Vito ^{[3
]}

Pham, Tai ^{[4
]}

Ranieri, V. Marco ^{[5
]}

Goligher, Ewan C. ^{[4
]}

Brodie, Daniel ^{[6
,7
]}

Pesenti, Antonio ^{[8
]}

Beale, Richard ^{[9
]}

Brochard, Laurent ^{[4
]}

Chiche, Jean-Daniel ^{[10
]}

Fan, Eddy ^{[11
]}

de Backer, Daniel ^{[12
]}

Francois, Guy ^{[13
]}

Ferguson, Niall ^{[11
]}

Laffey, John ^{[14
,15
]}

Mercat, Alain ^{[16
]}

McAuley, Daniel F. ^{[17
,18
]}

Mueller, Thomas ^{[19
]}

Quintel, Michael ^{[20
]}

Vincent, Jean-Louis ^{[21
]}

Taccone, Fabio Silvio ^{[21
]}

Peperstraete, Harlinde ^{[22
]}

Morimont, Philippe ^{[23
]}

Schmidt, Matthieu ^{[1
,2
]}

Levy, Bruno ^{[24
,25
]}

Diehl, Jean-Luc ^{[26
]}

Guervilly, Christophe ^{[27
]}

Capelier, Gilles ^{[28
]}

Vieillard-Baron, Antoine ^{[29
]}

Messika, Jonathan ^{[30
]}

Karagiannidis, Christian ^{[31
,32
]}

Moerer, Onnen ^{[20
]}

Urbino, Rosario ^{[3
]}

Antonelli, Massimo ^{[33
]}

Mojoli, Francesco ^{[34
]}

Alessandri, Francesco ^{[35
]}

Grasselli, Giacomo ^{[8
]}

Donker, Dirk ^{[36
]}

Ferrer, Ricard ^{[37
]}

Mancebo, Jordi ^{[38
]}

Slutsky, Arthur S. ^{[4
]}

机构：

[1] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, Inst Cardiometab & Nutr,INSERM,UMRS 1166,ICAN, Paris, France

[2] Sorbonne Univ, Hop Pitie Salpetriere, AP HP,ICAN, Serv Med Intens Reanimat,Inst Cardiol,INSERM,UMRS, Paris, France

[3] Univ Turin, Citta Salute & Sci Torino, Dept Anesthesia & Intens Care Med, Turin, Italy

[4] Univ Toronto, Keenan Res Ctr, Li Ka Shing Knowledge Inst, St Michaels Hosp,Interdept Div Crit Care Med, Toronto, ON, Canada

[5] Univ Bologna, Alma Mater Studiorum, Dipartimento Sci Med & Chirurg Anesthesia & Inten, Policlin St Orsola, Via Massarenti 9, I-40138 Bologna, Italy

[6] Columbia Univ, Coll Phys & Surg, Div Pulm Allergy & Crit Care Med, New York, NY USA

[7] New York Presbyterian Hosp, New York, NY USA

[8] Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy

[9] Guys & St Thomas NHS Fdn Trust, London, England

[10] Univ Paris 05, Hop Cochin, Paris, France

[11] Univ Toronto, Toronto Gen Hosp, Toronto, ON, Canada

[12] Univ Libre Bruxelles, Hop Braine Alleud Waterloo, Brussels, Belgium

[13] European Soc Intens Care Med, Brussels, Belgium

[14] Galway Univ Hosp, Galway, Ireland

[15] Natl Univ Ireland, Galway, Ireland

[16] Univ Angers, Ctr Hosp Univ, Angers, France

[17] Queens Univ Belfast, Ctr Expt Med, Belfast, Antrim, North Ireland

[18] Royal Victoria Hosp, Reg Intens Care Unit, Belfast, Antrim, North Ireland

[19] Univ Hosp Regensburg, Regensburg, Germany

[20] Univ Med Gottingen, Gottingen, Germany

[21] Univ Libre Bruxelles, Erasme Univ Hosp, Brussels, Belgium

[22] Ghent Univ Hosp, Ghent, Belgium

[23] Univ Hosp Liege, Liege, Belgium

[24] CHRU Nancy, Serv Reanimat Med Brabois, Pole Cardiomedicochirurg, INSERM,U1116,Fac Med, F-54511 Vandoeuvre Les Nancy, France

[25] Univ Lorraine, Nancy, France

[26] Hop Europeen Georges Pompidou, Paris, France

[27] Hop Nord Marseille, AP HM, Serv Med Intens Reanimat, Marseille, France

[28] Ctr Hosp Univ Besancon, Besancon, France

[29] Hop Ambroise Pare, Paris, France

[30] Hop Louis Mourier, Paris, France

[31] Kliniken Stadt Koln, Cologne, Germany

[32] Univ Witten Herdecke, Cologne, Germany

[33] Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy

[34] Fdn IRCCS Policlin San Matteo, Pavia, Italy

[35] Policlin Umberto 1, Rome, Italy

[36] Univ Utrecht, Med Ctr, Univ Med Ctr, Utrecht, Netherlands

[37] Hosp Univ Vall dHebron, Barcelona, Spain

[38] Hosp Santa Creu & Sant Pau, Barcelona, Spain

来源：

INTENSIVE CARE MEDICINE | 2019年 / 45卷 / 05期

关键词：

Acute respiratory distress syndrome; Mechanical ventilation; Extracorporeal carbon dioxide removal; Ventilator-induced lung injury; LUNG INJURY; 6; ML/KG; HYPERCAPNIA; PRESSURE; ECCO2R;

D O I：

10.1007/s00134-019-05567-4

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

PurposeWe assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate ultra-protective ventilation (V-T 4mL/kg and P(PLAT)25cmH(2)O) in patients with moderate acute respiratory distress syndrome (ARDS).MethodsProspective multicenter international phase 2 study. Primary endpoint was the proportion of patients achieving ultra-protective ventilation with PaCO2 not increasing more than 20% from baseline, and arterial pH>7.30. Severe adverse events (SAE) and ECCO2R-related adverse events (ECCO2R-AE) were reported to an independent data and safety monitoring board. We used lower CO2 extraction and higher CO2 extraction devices (membrane lung cross-sectional area 0.59 vs. 1.30m(2); flow 300-500mL/min vs. 800-1000mL/min, respectively).ResultsNinety-five patients were enrolled. The proportion of patients who achieved ultra-protective settings by 8h and 24h was 78% (74 out of 95 patients; 95% confidence interval 68-89%) and 82% (78 out of 95 patients; 95% confidence interval 76-88%), respectively. ECCO2R was maintained for 5 [3-8]days. Six SAEs were reported; two of them were attributed to ECCO2R (brain hemorrhage and pneumothorax). ECCO2R-AEs were reported in 39% of the patients. A total of 69 patients (73%) were alive at day 28. Fifty-nine patients (62%) were alive at hospital discharge.ConclusionsUse of ECCO2R to facilitate ultra-protective ventilation was feasible. A randomized clinical trial is required to assess the overall benefits and harms.Clinicaltrials.govNCT02282657

引用

页码：592 / 600

页数：9

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