Ding Xin, Chen Huan, Zhao Hua, Zhang Hongmin, He Huaiwu, Cheng Wei, Wang Chunyao, Jiang Wei, Ma Jie, Qin Yan, Liu Zhengyin, Wang Jinglan, Yan Xiaowei, Li Taisheng, Zhou Xiang, Long Yun, Zhang Shuyang
Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Front Med (Lausanne). 2021 Jul 8;8:654658. doi: 10.3389/fmed.2021.654658. eCollection 2021.
A phenotype of COVID-19 ARDS patients with extremely low compliance and refractory hypercapnia was found in our ICU. In the context of limited number of ECMO machines, feasibility of a low-flow extracorporeal carbon dioxide removal (ECCOR) based on the renal replacement therapy (RRT) platform in these patients was assessed. Single-center, prospective study. Refractory hypercapnia patients with COVID-19-associated ARDS were included and divided into the adjusted group and unadjusted group according to the level of PaCO after the application of the ECCOR system. Ventilation parameters [tidal volume (VT), respiratory rate, and PEEP], platform pressure (Pplat) and driving pressure (DP), respiratory system compliance, arterial blood gases, and ECCOR system characteristics were collected. Twelve patients with refractory hypercapnia were enrolled, and the PaCO was 64.5 [56-88.75] mmHg. In the adjusted group, VT was significantly reduced from 5.90 ± 0.16 to 5.08 ± 0.43 ml/kg PBW; DP and Pplat were also significantly reduced from 23.5 ± 2.72 mmHg and 29.88 ± 3.04 mmHg to 18.5 ± 2.62 mmHg and 24.75 ± 3.41 mmHg, respectively. In the unadjusted group, PaCO decreased from 94 [86.25, 100.3] mmHg to 80 [67.50, 85.25] mmHg but with no significant difference, and the DP and Pplat were not decreased after weighing the pros and cons. A low-flow ECCOR system based on the RRT platform enabled CO removal and could also decrease the DP and Pplat significantly, which provided a new way to treat these COVID-19 ARDS patients with refractory hypercapnia and extremely low compliance. https://www.clinicaltrials.gov/, identifier NCT04340414.
我们的重症监护病房发现了新冠肺炎急性呼吸窘迫综合征（ARDS）患者出现极低顺应性和难治性高碳酸血症的表型。在体外膜肺氧合（ECMO）机器数量有限的情况下，评估了基于肾脏替代治疗（RRT）平台的低流量体外二氧化碳清除（ECCOR）在这些患者中的可行性。单中心前瞻性研究。纳入新冠肺炎相关ARDS的难治性高碳酸血症患者，并根据应用ECCOR系统后的动脉血二氧化碳分压（PaCO₂）水平分为调整组和未调整组。收集通气参数[潮气量（VT）、呼吸频率和呼气末正压（PEEP）]、平台压（Pplat）和驱动压（DP）、呼吸系统顺应性、动脉血气以及ECCOR系统特征。纳入12例难治性高碳酸血症患者，PaCO₂为64.5[56 - 88.75]mmHg。在调整组中，VT从5.90±0.16显著降至5.08±0.43ml/kg预计体重；DP和Pplat也分别从23.5±2.72mmHg和29.88±3.04mmHg显著降至18.5±2.62mmHg和24.75±3.41mmHg。在未调整组中，PaCO₂从94[86.25, 100.3]mmHg降至80[67.50, 85.25]mmHg，但差异无统计学意义，权衡利弊后DP和Pplat未降低。基于RRT平台的低流量ECCOR系统能够实现二氧化碳清除，还能显著降低DP和Pplat，为治疗这些伴有难治性高碳酸血症和极低顺应性的新冠肺炎ARDS患者提供了一种新方法。https://www.clinicaltrials.gov/，标识符NCT04340414 。
