Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial.

Autor: Duggal A; Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio., Conrad SA; Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana., Barrett NA; Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.; Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom., Saad M; Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky., Cheema T; Division of Pulmonary Critical Care, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania., Pannu S; Division of Pulmonary Critical Care and Sleep, Department of Medicine, Ohio State University, Columbus, Ohio., Romero RS; Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota., Brochard L; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada., Nava S; Respiratory and Critical Care Unit, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy., Ranieri VM; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.; Anesthesia and Intensive Care Medicine, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy., May A; ALung Technologies, LivaNova PLC, Pittsburgh, Pennsylvania., Brodie D; Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and., Hill NS; Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2024 Mar 01; Vol. 209 (5), pp. 529-542.
DOI: 10.1164/rccm.202311-2060OC
Abstrakt: Rationale: It is unclear whether extracorporeal CO 2 removal (ECCO 2 R) can reduce the rate of intubation or the total time on invasive mechanical ventilation (IMV) in adults experiencing an exacerbation of chronic obstructive pulmonary disease (COPD). Objectives: To determine whether ECCO 2 R increases the number of ventilator-free days within the first 5 days postrandomization (VFD-5) in exacerbation of COPD in patients who are either failing noninvasive ventilation (NIV) or who are failing to wean from IMV. Methods: This randomized clinical trial was conducted in 41 U.S. institutions (2018-2022) (ClinicalTrials.gov ID: NCT03255057). Subjects were randomized to receive either standard care with venovenous ECCO 2 R (NIV stratum: n  = 26; IMV stratum: n  = 32) or standard care alone (NIV stratum: n  = 22; IMV stratum: n  = 33). Measurements and Main Results: The trial was stopped early because of slow enrollment and enrolled 113 subjects of the planned sample size of 180. There was no significant difference in the median VFD-5 between the arms controlled by strata ( P  = 0.36). In the NIV stratum, the median VFD-5 for both arms was 5 days (median shift = 0.0; 95% confidence interval [CI]: 0.0-0.0). In the IMV stratum, the median VFD-5 in the standard care and ECCO 2 R arms were 0.25 and 2 days, respectively; median shift = 0.00 (95% confidence interval: 0.00-1.25). In the NIV stratum, all-cause in-hospital mortality was significantly higher in the ECCO 2 R arm (22% vs. 0%, P  = 0.02) with no difference in the IMV stratum (17% vs. 15%, P  = 0.73). Conclusions: In subjects with exacerbation of COPD, the use of ECCO 2 R compared with standard care did not improve VFD-5. Clinical trial registered with www.clinicaltrials.gov (NCT03255057).
Databáze: MEDLINE
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