Zhang Ruhan, Tian Chao, Cai Shuhan, Ma Jing, Li Jin, Li Zhaoyang, You Jinkun, Ding Xinbo, Peng Zhiyong
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Hubei Clinical Research Center for Critical Care Medicine, Wuhan, China.
Blood Purif. 2023;52(2):132-139. doi: 10.1159/000525867. Epub 2022 Jul 27.
Low-flow extracorporeal carbon dioxide removal (LF-ECCO2R) has the potential to play an important role in the management of adults with acute respiratory failure. However, it has never been tested in China. The study aimed at exploring the safety and efficacy on LF-ECCO2R for acute respiratory failure in a Chinese tertiary intensive care unit (ICU).
We performed a retrospective case note review of patients admitted to our tertiary regional ICU and commenced on LF-ECCO2R from June 2020 to September 2021. The LF-ECCO2R device we used was ProLUNG® system (Estor S.p.A., Milan, Italy). The device employed a nonporous poly-4-methyl-1-pentene membrane lung with a surface area of 1.81 m2 and run at an extracorporeal blood flow between 100 and 450 mL/min. Demographic and physiologic data (including ventilation parameters and arterial blood gases) as well as the outcome of LF-ECCO2R treatment were recorded.
A total of 12 cases were included. A statistically significant reduction in respiratory rate, driving pressure, PaCO2, and blood lactate was observed. In addition, there was a statistically significant improvement in pH and PaO2/FiO2. Six out of 12 patients (50%) were discharged alive from ICU. Three complications related to LF-ECCO2R were reported, none resulting in serious adverse outcomes.
Our clinical series indicated that LF-ECCO2R seemed to be safely applied in patients with acute respiratory failure. The efficacy of CO2 removal as well as the improved respiratory parameters was also observed. However, large-scale randomized clinical trials are needed to confirm the effects.
低流量体外二氧化碳清除（LF-ECCO2R）在成人急性呼吸衰竭的管理中可能发挥重要作用。然而，在中国尚未进行过相关测试。本研究旨在探讨LF-ECCO2R在中国一家三级重症监护病房（ICU）中治疗急性呼吸衰竭的安全性和有效性。
我们对2020年6月至2021年9月期间入住我院三级区域ICU并开始接受LF-ECCO2R治疗的患者进行了回顾性病例记录审查。我们使用的LF-ECCO2R设备是ProLUNG®系统（意大利米兰的Estor S.p.A.公司）。该设备采用表面积为1.81平方米的无孔聚4-甲基-1-戊烯膜肺，体外血流量在100至450毫升/分钟之间运行。记录了人口统计学和生理学数据（包括通气参数和动脉血气）以及LF-ECCO2R治疗的结果。
共纳入12例患者。观察到呼吸频率、驱动压力、PaCO2和血乳酸有统计学意义的降低。此外，pH值和PaO2/FiO2有统计学意义的改善。12例患者中有6例（50%）从ICU存活出院。报告了3例与LF-ECCO2R相关的并发症，均未导致严重不良后果。
我们的临床系列研究表明，LF-ECCO2R似乎可安全应用于急性呼吸衰竭患者。还观察到了二氧化碳清除的效果以及呼吸参数的改善。然而，需要大规模随机临床试验来证实这些效果。
