Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study
Por:
Combes, A, Tonetti, T, Fanelli, V, Pham, T, Pesenti, A, Mancebo, J, Brodie, D, Ranieri, VM
Publicada:
1 dic 2019
Resumen:
Retrospective analysis of the SUPERNOVA trial exploring the hypothesis that efficacy and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate reduction of tidal volume (V-T) to 4mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59m(2); blood flow 300-500mL/min) and higher (membrane area 1.30m(2); blood flow between 800 and 1000mL/min) CO2 extraction capacity. Ninety-five patients with moderate ARDS were included (33 patients treated with lower and 62 patients treated with higher CO2 extraction devices). We found that (1) V-T of 4mL/kg was reached by 55% and 64% of patients with the lower extraction versus 90% and 92% of patients with higher extraction devices at 8 and 24hours from baseline, respectively (p<0.001), and (2) percentage of patients experiencing episodes of ECCO2R-related haemolysis and bleeding was higher with lower than with higher extraction devices (21% vs 6%, p=0.045%and 27% vs 6%, p=0.010, respectively). Although V (T) of 4mL/kg could have been obtained with all devices, this was achieved frequently and with a lower rate of adverse events by devices with higher CO2 extraction capacity.
Filiaciones:
Combes, A:
Hop Univ Pitie Salpetriere, Paris, France
Tonetti, T:
Georg August Univ Gottingen, Dept Anesthesiol, Gottingen, Germany
Fanelli, V:
Univ Torino, Turin, Italy
Pham, T:
Hop Tenon, AP HP, Pole Thorax Voies Aeriennes, Unite Reanimat Medicochirurg, Paris, France
Pesenti, A:
Univ Milan, Dipartimento Fisiopatol Medicochirurg & Trapianti, Milan, Italy
Fdn IRCCS Osped Maggiore Policlin Mangiagalli & R, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Mancebo, J:
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Brodie, D:
Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA
Ranieri, VM:
Univ Bologna, Anesthesia & Intens Care Med, Policlin St Orsola, Bologna, Italy
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