Bein, Thomas and Weber-Carstens, Steffen and Goldmann, Anton and Mueller, Thomas and Staudinger, Thomas and Brederlau, Joerg and Muellenbach, Ralf and Dembinski, Rolf and Graf, Bernhard M. and Wewalka, Marlene and Philipp, Alois and Wernecke, Klaus-Dieter and Lubnow, Matthias and Slutsky, Arthur S. (2013) Lower tidal volume strategy (approximate to 3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS. INTENSIVE CARE MEDICINE, 39 (5). pp. 847-856. ISSN 0342-4642, 1432-1238
Full text not available from this repository. (Request a copy)Abstract
Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V (T)) strategy (V (T) a parts per thousand 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Seventy-nine patients were enrolled after a 'stabilization period' (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V (T) ventilation (a parts per thousand 3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (a parts per thousand 6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality. Ventilation with very low V (T)'s was easy to implement with extracorporeal CO2-removal. VFD's within 60 days were not different between the study group (33.2 +/- A 20) and the control group (29.2 +/- A 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 a parts per thousand currency sign150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 +/- A 12.8) compared to control (28.2 +/- A 16.4, p = 0.033). The mortality rate was low (16.5 %) and did not differ between groups. The use of very low V (T) combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a 'normal' lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTERVENTIONAL LUNG ASSIST; MECHANICAL VENTILATION; INJURY; HYPERINFLATION; OXYGENATION; PRESSURES; Lung protective ventilation; Pumpless extracorporeal lung support; Carbon dioxide removal; Acute respiratory distress syndrome; Ultraprotective ventilation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 16 Apr 2020 05:52 |
| Last Modified: | 16 Apr 2020 05:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/16762 |
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