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

被引：174

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

共 25 条

[1] Driving Pressure and Survival in the Acute Respiratory Distress Syndrome
Amato, Marcelo B. P.
Meade, Maureen O.
Slutsky, Arthur S.
Brochard, Laurent
Costa, Eduardo L. V.
Schoenfeld, David A.
Stewart, Thomas E.
Briel, Matthias
Talmor, Daniel
Mercat, Alain
Richard, Jean-Christophe M.
Carvalho, Carlos R. R.
Brower, Roy G.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (08) : 747 - 755
[2] Lower tidal volume strategy (≈ 3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS
Bein, Thomas
Weber-Carstens, Steffen
Goldmann, Anton
Mueller, Thomas
Staudinger, Thomas
Brederlau, Joerg
Muellenbach, Ralf
Dembinski, Rolf
Graf, Bernhard M.
Wewalka, Marlene
Philipp, Alois
Wernecke, Klaus-Dieter
Lubnow, Matthias
Slutsky, Arthur S.
[J]. INTENSIVE CARE MEDICINE, 2013, 39 (05) : 847 - 856
[3] Lung Regional Metabolic Activity and Gas Volume Changes Induced by Tidal Ventilation in Patients with Acute Lung Injury
Bellani, Giacomo
Guerra, Luca
Musch, Guido
Zanella, Alberto
Patroniti, Nicolo
Mauri, Tommaso
Messa, Cristina
Pesenti, Antonio
[J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 183 (09) : 1193 - 1199
[4] Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
Brower, RG
Matthay, MA
Morris, A
Schoenfeld, D
Thompson, BT
Wheeler, A
Wiedemann, HP
Arroliga, AC
Fisher, CJ
Komara, JJ
Perez-Trepichio, P
Parsons, PE
Wolkin, R
Welsh, C
Fulkerson, WJ
MacIntyre, N
Mallatratt, L
Sebastian, M
McConnell, R
Wilcox, C
Govert, J
Thompson, D
Clemmer, T
Davis, R
Orme, J
Weaver, L
Grissom, C
Eskelson, M
Young, M
Gooder, V
McBride, K
Lawton, C
d'Hulst, J
Peerless, JR
Smith, C
Brownlee, J
Pluss, W
Kallet, R
Luce, JM
Gottlieb, J
Elmer, M
Girod, A
Park, P
Daniel, B
Gropper, M
Abraham, E
Piedalue, F
Glodowski, J
Lockrem, J
McIntyre, R
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (18) : 1301 - 1308
[5] Bench-to-bedside review: Carbon dioxide
Curley, Gerard
Laffey, John G.
Kavanagh, Brian P.
[J]. CRITICAL CARE, 2010, 14 (02):
[6] Use of extracorporeal carbon dioxide removal (ECCO2R) in 239 intensive care units: results from a French national survey
Deniau, B.
Ricard, J. D.
Messika, J.
Dreyfuss, D.
Gaudry, Stephane
[J]. INTENSIVE CARE MEDICINE, 2016, 42 (04) : 624 - 625
[7] From ventilator-induced lung injury to multiple organ dysfunction?
Dreyfuss, D
Saumon, G
[J]. INTENSIVE CARE MEDICINE, 1998, 24 (02) : 102 - 104
[8] Extracorporeal CO2 Removal: The Minimally Invasive Approach, Theory, and Practice
Duscio, Eleonora
Cipulli, Francesco
Vasques, Francesco
Collino, Francesca
Rapetti, Francesca
Romitti, Federica
Behnemann, Tim
Niewenhuys, Julia
Tonetti, Tommaso
Pasticci, Iacopo
Vassalli, Francesco
Reupke, Verena
Moerer, Onnen
Quintel, Michael
Gattinoni, Luciano
[J]. CRITICAL CARE MEDICINE, 2019, 47 (01) : 33 - 40
[9] Extracorporeal Support for Severe Acute Respiratory Failure
Fanelli, V.
Costamagna, A.
Ranieri, V. Marco
[J]. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2014, 35 (04) : 519 - 527
[10] Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome
Fanelli, Vito
Ranieri, Marco V.
Mancebo, Jordi
Moerer, Onnen
Quintel, Michael
Morley, Scott
Moran, Indalecio
Parrilla, Francisco
Costamagna, Andrea
Gaudiosi, Marco
Combes, Alain
[J]. CRITICAL CARE, 2016, 20

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