Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study
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 (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower...
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| Veröffentlicht in: | Thorax 2019-12, Vol.74 (12), p.1179-1181 |
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| creator | Combes, Alain Tonetti, Tommaso Fanelli, Vito Pham, Tai Pesenti, Antonio Mancebo, Jordi Brodie, Daniel Ranieri, V Marco |
| description | 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 (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59 m2; blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/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) VT of 4 mL/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 24 hours from baseline, respectively (p |
| doi_str_mv | 10.1136/thoraxjnl-2019-213591 |
| format | Article |
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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) VT of 4 mL/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 24 hours 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 4 mL/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.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thoraxjnl-2019-213591</identifier><identifier>PMID: 31409646</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Thoracic Society</publisher><subject>acute respiratory distress syndrome ; Brief communication ; Carbon dioxide ; Carbon dioxide removal ; Catheters ; Clinical trials ; extracorporeal carbon dioxide removal ; Intensive care ; mechanical ventilation ; Respiratory distress syndrome ; Thrombocytopenia ; ventilator-induced lung injury ; Ventilators</subject><ispartof>Thorax, 2019-12, Vol.74 (12), p.1179-1181</ispartof><rights>Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b276t-f122060c2af83861d7a4e9bee4c555f05fa81c4baf2252faf0ee87ac4e8d120b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Combes, Alain</creatorcontrib><creatorcontrib>Tonetti, Tommaso</creatorcontrib><creatorcontrib>Fanelli, Vito</creatorcontrib><creatorcontrib>Pham, Tai</creatorcontrib><creatorcontrib>Pesenti, Antonio</creatorcontrib><creatorcontrib>Mancebo, Jordi</creatorcontrib><creatorcontrib>Brodie, Daniel</creatorcontrib><creatorcontrib>Ranieri, V Marco</creatorcontrib><title>Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study</title><title>Thorax</title><addtitle>Thorax</addtitle><description>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 (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59 m2; blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/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) VT of 4 mL/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 24 hours 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 4 mL/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.</description><subject>acute respiratory distress syndrome</subject><subject>Brief communication</subject><subject>Carbon dioxide</subject><subject>Carbon dioxide removal</subject><subject>Catheters</subject><subject>Clinical trials</subject><subject>extracorporeal carbon dioxide removal</subject><subject>Intensive care</subject><subject>mechanical ventilation</subject><subject>Respiratory distress syndrome</subject><subject>Thrombocytopenia</subject><subject>ventilator-induced lung injury</subject><subject>Ventilators</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kc-O0zAQxi0EYsvCIyBZ4sIl4HEcx-G2qsofaUURsFyjiTOmqdx4iZ2yfQzeGEdFi8SBkzXy75tvZj7GnoN4BVDq12kXJrzbj76QAppCQlk18ICtQGlTlLLRD9lKCCUKXdb6gj2JcS-EMAD1Y3ZRghKNVnrFfm2cGyzaE8ex5xEdpRMPjvvwkyZ-pCnOke-G77tcrbeS012a0KYhjLyn42Ap8hQ4-szz2ee_2ykkysCRsnpMg8cFfsMj2TD2OC1G6E9xiItN2hH_cvNp8_nj9tsVj2nuT0_ZI4c-0rM_7yW7ebv5un5fXG_ffVhfXRedrHUqHEgptLASnSmNhr5GRU1HpGxVVU5UDg1Y1aGTspIOnSAyNVpFpgcpuvKSvTz3zRP_mCmm9jBES97jSGGOrZR1mR1MLTP64h90H-Ypr5GpfEploKkWSpyp7rBvb6fhkJdtQbRLXO19XO0SV3uOK0vgr-S-5_81vwGvrZuk</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Combes, Alain</creator><creator>Tonetti, Tommaso</creator><creator>Fanelli, Vito</creator><creator>Pham, Tai</creator><creator>Pesenti, Antonio</creator><creator>Mancebo, Jordi</creator><creator>Brodie, Daniel</creator><creator>Ranieri, V Marco</creator><general>BMJ Publishing Group Ltd and British Thoracic Society</general><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20191201</creationdate><title>Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study</title><author>Combes, Alain ; 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blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/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) VT of 4 mL/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 24 hours 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 4 mL/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.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Thoracic Society</pub><pmid>31409646</pmid><doi>10.1136/thoraxjnl-2019-213591</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | acute respiratory distress syndrome Brief communication Carbon dioxide Carbon dioxide removal Catheters Clinical trials extracorporeal carbon dioxide removal Intensive care mechanical ventilation Respiratory distress syndrome Thrombocytopenia ventilator-induced lung injury Ventilators |
| title | Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study |
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