■高碳酸血症会加重急性呼吸窘迫综合征(ARDS)期间的肺血管功能障碍。我们测试了基于肾脏替代疗法平台(Prismalung®)的体外二氧化碳去除(ECCO2R)装置是否可以降低PaCO2并减轻ARDS难治性高碳酸血症患者的肺血管功能障碍。
■我们计划前瞻性纳入20名中度至重度ARDS患者,肺血管功能障碍的超声心动图,尽管仪器死区减少和呼吸频率增加,但PaCO2≥48mmHg。血流动力学,超声心动图,呼吸力学,和动脉血气记录在2(H2),6(H6)和24(H24)小时的ECCO2R处理持续至少24小时。
■仅包括8名患者,由于ECCO2R膜的全球短缺和大流行,该研究被终止。只有一名患者在H2时满足主要终点标准(PaCO2下降超过20%),但在H6时一半的患者(n=4)实现了这一目标。PaCO2值<48mmHg的患者百分比随时间增加,从H0的0/8(0%)到H2的3/8(37.5%)和H6的4/8(50%)(p=0.04)。ECCO2R的血流动力学和超声心动图变量没有重大变化,除了心率显著下降.5例(62.5%)患者在H24之前提前停用ECCO2R,由于膜凝血在所有情况下。
■这项初步研究测试显示,该系统的第一个版本具有狭窄的功效和高的膜血栓形成率。改进的版本应该在未来的试验中进行测试。
■在clinicaltrials.gov注册,标识符:NCT03303807,注册:2017年10月6日,https://clinicaltrials.gov/ct2/show/NCT03303807。
UNASSIGNED: Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia.
UNASSIGNED: We planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h.
UNASSIGNED: Only eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases.
UNASSIGNED: This pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials.
UNASSIGNED: Registered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807.