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Low flow extracorporeal CO2 removal in ARDS patients : a prospective short-term crossover pilot study

Harlinde Peperstraete (UGent) , Sunny Eloot (UGent) , Pieter Depuydt (UGent) , Filip De Somer (UGent) , Carl Roosens (UGent) and Eric Hoste (UGent)
Author
Organization
Abstract
Background: Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis. This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R). Methods: This was a prospective pilot study, using the Abylcap (R) (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h. Adverse events (AE) were recorded prospectively. We included 10 ARDS patients on MV, with PaO2/FiO(2) < 150 mmHg, tidal volume <= 8 mL/kg with positive end-expiratory pressure >= 5 cmH(2)O, FiO(2) titrated to SaO(2) 88-95%, plateau pressure >= 28 cmH(2)O, and respiratory acidosis (pH < 7.25). Results: After 2-h of ECCO2R, 6 patients had a >= 20% decrease in PaCO2 (60%); PaCO2 decreased 28.4% (from 58.4 to 48. 7 mmHg, p = 0.005), and pH increased (1.59%, p = 0.005). ECCO2R was hemodynamically well tolerated. During the whole period of ECCO2R, 6 patients had an AE (60%); bleeding occurred in 5 patients (50%) and circuit thrombosis in 3 patients (30%), these were judged not to be life threatening. Conclusions: In ARDS patients, low flow ECCO2R significantly reduced PaCO2 after 2 h, Follow up during the entire ECCO2R period revealed a high incidence of bleeding and circuit thrombosis.
Keywords
RESPIRATORY-DISTRESS-SYNDROME, CARBON-DIOXIDE REMOVAL, ACUTE LUNG, INJURY, INTENSIVE-CARE UNITS, NONINVASIVE VENTILATION, MECHANICAL, VENTILATION, PERMISSIVE HYPERCAPNIA, PROTECTIVE VENTILATION, BERLIN, DEFINITION, CO-2 REMOVAL, Acute respiratory distress syndrome, Lung protective mechanical, ventilation, Extracorporeal carbon dioxide removal, Plateau pressure, Driving pressure

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MLA
Peperstraete, Harlinde, Sunny Eloot, Pieter Depuydt, et al. “Low Flow Extracorporeal CO2 Removal in ARDS Patients : a Prospective Short-term Crossover Pilot Study.” BMC ANESTHESIOLOGY 17 (2017): n. pag. Print.
APA
Peperstraete, H., Eloot, S., Depuydt, P., De Somer, F., Roosens, C., & Hoste, E. (2017). Low flow extracorporeal CO2 removal in ARDS patients : a prospective short-term crossover pilot study. BMC ANESTHESIOLOGY, 17.
Chicago author-date
Peperstraete, Harlinde, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, and Eric Hoste. 2017. “Low Flow Extracorporeal CO2 Removal in ARDS Patients : a Prospective Short-term Crossover Pilot Study.” Bmc Anesthesiology 17.
Chicago author-date (all authors)
Peperstraete, Harlinde, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, and Eric Hoste. 2017. “Low Flow Extracorporeal CO2 Removal in ARDS Patients : a Prospective Short-term Crossover Pilot Study.” Bmc Anesthesiology 17.
Vancouver
1.
Peperstraete H, Eloot S, Depuydt P, De Somer F, Roosens C, Hoste E. Low flow extracorporeal CO2 removal in ARDS patients : a prospective short-term crossover pilot study. BMC ANESTHESIOLOGY. 2017;17.
IEEE
[1]
H. Peperstraete, S. Eloot, P. Depuydt, F. De Somer, C. Roosens, and E. Hoste, “Low flow extracorporeal CO2 removal in ARDS patients : a prospective short-term crossover pilot study,” BMC ANESTHESIOLOGY, vol. 17, 2017.
@article{8542693,
  abstract     = {Background: Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis. This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R). 
Methods: This was a prospective pilot study, using the Abylcap (R) (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h. Adverse events (AE) were recorded prospectively. We included 10 ARDS patients on MV, with PaO2/FiO(2) < 150 mmHg, tidal volume <= 8 mL/kg with positive end-expiratory pressure >= 5 cmH(2)O, FiO(2) titrated to SaO(2) 88-95%, plateau pressure >= 28 cmH(2)O, and respiratory acidosis (pH < 7.25). 
Results: After 2-h of ECCO2R, 6 patients had a >= 20% decrease in PaCO2 (60%); PaCO2 decreased 28.4% (from 58.4 to 48. 7 mmHg, p = 0.005), and pH increased (1.59%, p = 0.005). ECCO2R was hemodynamically well tolerated. During the whole period of ECCO2R, 6 patients had an AE (60%); bleeding occurred in 5 patients (50%) and circuit thrombosis in 3 patients (30%), these were judged not to be life threatening. 
Conclusions: In ARDS patients, low flow ECCO2R significantly reduced PaCO2 after 2 h, Follow up during the entire ECCO2R period revealed a high incidence of bleeding and circuit thrombosis.},
  articleno    = {155},
  author       = {Peperstraete, Harlinde and Eloot, Sunny and Depuydt, Pieter and De Somer, Filip and Roosens, Carl and Hoste, Eric},
  issn         = {1471-2253},
  journal      = {BMC ANESTHESIOLOGY},
  keywords     = {RESPIRATORY-DISTRESS-SYNDROME,CARBON-DIOXIDE REMOVAL,ACUTE LUNG,INJURY,INTENSIVE-CARE UNITS,NONINVASIVE VENTILATION,MECHANICAL,VENTILATION,PERMISSIVE HYPERCAPNIA,PROTECTIVE VENTILATION,BERLIN,DEFINITION,CO-2 REMOVAL,Acute respiratory distress syndrome,Lung protective mechanical,ventilation,Extracorporeal carbon dioxide removal,Plateau pressure,Driving pressure},
  language     = {eng},
  pages        = {9},
  title        = {Low flow extracorporeal CO2 removal in ARDS patients : a prospective short-term crossover pilot study},
  url          = {http://dx.doi.org/10.1186/s12871-017-0445-9},
  volume       = {17},
  year         = {2017},
}

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