McNamee J J, Gillies M A, Barrett N A, Agus A M, Beale R, Bentley A, Bodenham A, Brett S J, Brodie D, Finney S J, Gordon A J, Griffiths M, Harrison D, Jackson C, McDowell C, McNally C, Perkins G D, Tunnicliffe W, Vuylsteke A, Walsh T S, Wise M P, Young D, McAuley D F
Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.
Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK.
J Intensive Care Soc. 2017 May;18(2):159-169. doi: 10.1177/1751143716681035. Epub 2016 Dec 19.
One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCOR) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCOR in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCOR and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCOR in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.
在少数已证明可改善急性低氧性呼吸衰竭预后的干预措施中，机械通气时降低潮气量是其中之一，这通常被称为肺保护性通气。静脉-静脉体外二氧化碳清除（vv-ECCOR）有助于降低潮气量。静脉-静脉肺辅助保护性通气（REST）是一项随机、分配隐藏、对照、开放、多中心实用性试验，旨在确定vv-ECCOR辅助下的低潮气量机械通气对急性低氧性呼吸衰竭患者的临床疗效和成本效益。因急性低氧性呼吸衰竭需要插管和机械通气的患者将被随机分配接受vv-ECCOR和低潮气量机械通气，或按招募中心分层接受标准治疗。需要进行一项大型随机对照试验，以确定急性低氧性呼吸衰竭患者使用vv-ECCOR是否能采用更具保护性的肺通气策略，并改善患者预后。
