Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome.

Autor: Husain-Syed F; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy., Birk HW; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Wilhelm J; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany.; Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany., Ronco C; International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.; Department of Medicine (DIMED), Università di Padova, Padua, Italy., Ranieri VM; Department of Medical and Surgical Sciences (DIMEC), Anaesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy., Karle B; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Kuhnert S; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Tello K; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany., Hecker M; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany., Morty RE; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany.; Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany., Herold S; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany., Kehl O; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Walmrath HD; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Seeger W; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany.; Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany.; Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany., Vadász I; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.; The Cardio-Pulmonary Institute, Giessen, Germany.
Jazyk: angličtina
Zdroj: Frontiers in medicine [Front Med (Lausanne)] 2020 Nov 12; Vol. 7, pp. 598379. Date of Electronic Publication: 2020 Nov 12 (Print Publication: 2020).
DOI: 10.3389/fmed.2020.598379
Abstrakt: Coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Extracorporeal carbon dioxide removal (ECCO 2 R) has been proposed as an adjuvant therapy to avoid progression of clinical severity and limit further ventilator-induced lung injury, but its use in COVID-19 has not been described yet. Acute kidney injury requiring renal replacement therapy (RRT) is common among critically ill COVID-19 patients. In centers with available dialysis, low-flow ECCO 2 R (<500 mL/min) using RRT platforms could be carried out by dialysis specialists and might be an option to efficiently allocate resources during the COVID-19 pandemic for patients with hypercapnia as the main indication. Here, we report the feasibility, safety, and efficacy of ECCO 2 R using an RRT platform to provide either standalone ECCO 2 R or ECCO 2 R combined with RRT in four hypercapnic patients with moderate ARDS. A randomized clinical trial is required to assess the overall benefit and harm. Clinical Trial Registration: ClinicalTrials.gov. Unique identifier: NCT04351906.
(Copyright © 2020 Husain-Syed, Birk, Wilhelm, Ronco, Ranieri, Karle, Kuhnert, Tello, Hecker, Morty, Herold, Kehl, Walmrath, Seeger and Vadász.)
Databáze: MEDLINE
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