Monet Clément, Renault Thomas, Aarab Yassir, Pensier Joris, Prades Albert, Lakbar Ines, Le Bihan Clément, Capdevila Mathieu, De Jong Audrey, Molinari Nicolas, Jaber Samir
Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, PhyMedExp, INSERM U1046, CNRS UMR, University of Montpellier, 9214, Montpellier Cedex 5, France.
PhyMedExp, INSERM U1046, CNRS UMR, University of Montpellier, 9214, Montpellier, France.
Crit Care. 2024 Dec 27;28(1):433. doi: 10.1186/s13054-024-05168-8.
Ultra-protective ventilation is the combination of low airway pressures and tidal volume (Vt) combined with extra corporeal carbon dioxide removal (ECCOR). A recent large study showed no benefit of ultra-protective ventilation compared to standard ventilation in ARDS (Acute Respiratory Distress Syndrome) patients. However, the reduction in Vt failed to achieve the objective of less than or equal to 3 ml/kg predicted body weight (PBW). The main objective of our study was to assess the feasibility of the ultra-low volume ventilation (Vt ≤ 3 ml/kg PBW) facilitated by ECCOR in acute respiratory failure patients.
Retrospective analysis of a prospective cohort of patients with either high or low blood flow veno-venous ECCOR devices. A session was defined as a treatment of ECCOR from the start to the removal of the device (one patient could have one more than one session). Primary endpoint was the proportion of sessions during which a Vt less or equal to 3 ml/kg PBW at 24 h after the start of ECCOR was successfully achieved for at least 12 h. Secondary endpoints were respiratory variables, rate of adverse events and outcomes.
Forty-five ECCOR sessions were recorded among 41 patients. Ultra-low volume ventilation (tidal volume ≤ 3 ml/kg PBW, success group) was successfully achieved at 24 h in 40.0% sessions (18 out of 45 sessions, confidence interval 25.3-54.6%). At 24 h, tidal volume in the failure group was 4.1 [3.8-4.5] ml/kg PBW compared to 2.1 [1.9-2.5] in the success group (p < 0.001). After multivariate analysis, blood flow rate was significantly associated with success of ultra-low volume ventilation (adjusted OR per 100 ml/min increase 1.51 (95%CI 1.21-1.90, p = 0.0003).
Ultra-low volume ventilation (≤ 3 ml/kg PBW) was feasible in 18 out of 45 sessions. Higher blood flow rates were associated with the success of ultra-low volume ventilation.
超保护性通气是低气道压力和潮气量（Vt）与体外二氧化碳清除（ECCOR）相结合的通气方式。最近一项大型研究表明，在急性呼吸窘迫综合征（ARDS）患者中，与标准通气相比，超保护性通气并无益处。然而，潮气量的降低未能达到小于或等于3 ml/kg预测体重（PBW）的目标。我们研究的主要目的是评估在急性呼吸衰竭患者中，由ECCOR辅助的超低容量通气（Vt≤3 ml/kg PBW）的可行性。
对使用高血流量或低血流量静脉-静脉ECCOR设备的前瞻性队列患者进行回顾性分析。一个疗程定义为从开始使用ECCOR到移除设备的治疗过程（一名患者可能有一个以上疗程）。主要终点是在开始ECCOR治疗24小时后，Vt小于或等于3 ml/kg PBW且至少持续12小时的疗程比例。次要终点是呼吸变量、不良事件发生率和结局。
41例患者共记录了45个ECCOR疗程。40.0%的疗程（45个疗程中的18个，置信区间25.3 - 54.6%）在24小时成功实现了超低容量通气（潮气量≤3 ml/kg PBW，成功组）。在24小时时，失败组的潮气量为4.1[3.8 - 4.5]ml/kg PBW，而成功组为2.1[1.9 - 2.5]ml/kg PBW（p < 0.001）。多因素分析后，血流量与超低容量通气的成功显著相关（每增加100 ml/min调整后的OR为1.51（95%CI 1.21 - 1.90，p = 0.0003）。
45个疗程中有18个成功实现了超低容量通气（≤3 ml/kg PBW）。较高的血流量与超低容量通气的成功相关。
