Extracorporeal CO2 Removal During Renal Replacement Therapy to Allow Lung-Protective Ventilation in Patients With COVID-19–Associated Acute Respiratory Distress Syndrome. Issue 1 (28th December 2022)

• Record Type: Journal Article
• Authors: Alessandri, Francesco; Tonetti, Tommaso; Pistidda, Laura; Busani, Stefano; Borrazzo, Cristian; Fanelli, Vito; Polzoni, Mauro; Piazza, Ornella; Lorini, Luca; Cattaneo, Sergio; Ricci, Davide; Zanoni, Andrea; Girardis, Massimo; Terragni, Pierpaolo; Tempesta, Michele; Di Luca, Marina; Pugliese, Francesco; Ranieri, V. Marco
• Other Names: Aldegheri Giorgio author non-byline.; Alessandri Francesco author non-byline.; Bernd Claus author non-byline.; Borrazzo Cristian author non-byline.; Brivio Matteo author non-byline.; Busani Stefano author non-byline.; Catorze Nuno author non-byline.; Cattaneo Sergio author non-byline.; Corcione Antonio author non-byline.; Dall'Ara Lorenzo author non-byline.; Dauri Mario author non-byline.; Di Luca Marina author non-byline.; Fanelli Vito author non-byline.; Fumagalli Roberto author non-byline.; Gianni Giulia author non-byline.; Giordano Giovanni author non-byline.; Girardis Massimo author non-byline.; Grasso Salvatore author non-byline.; Grazioli Lorenzo author non-byline.; Novelli Martina author non-byline.; Lamas Tomás author non-byline.; Lorini Luca author non-byline.; Margola Alessio author non-byline.; Palumbo Roberto author non-byline.; Piazza Ornella author non-byline.; Piazzolla Mario author non-byline.; Pistidda Laura author non-byline.; Pistolesi Valentina author non-byline.; Polzoni Mauro author non-byline.; Possick Valeria author non-byline.; Pugliese Francesco author non-byline.; Ribeiro Inês author non-byline.; Ricci Davide author non-byline.; Ranieri V. Marco author non-byline.; Oliveira Filipa author non-byline.; Storti Enrico author non-byline.; Salaris Davide author non-byline.; Terragni Pierpaolo author non-byline.; Tonetti Tommaso author non-byline.; Winding Robert Ravholt author non-byline.; Tempesta Michele author non-byline.; Urbino Rosario author non-byline.; Zanoni Andrea author non-byline.;
• Is Part Of: ASAIO journal. Volume 69:Issue 1(2023)
• Page Start: 36
• Page End: 42
• Publication Date: 2022-12-28
• Subjects: ECCO2R -- RRT -- COVID-19 -- ultraprotective ventilation; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001803
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : The aim of this retrospective multicenter observational study is to test the feasibility and safety of a combined extracorporeal CO2 removal (ECCO2 R) plus renal replacement therapy (RRT) system to use an ultraprotective ventilator setting while maintaining (1) an effective support of renal function and (2) values of pH within the physiologic limits in a cohort of coronavirus infectious disease 2019 (COVID-19) patients. Among COVID-19 patients admitted to the intensive care unit of 9 participating hospitals, 27 patients with acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) requiring invasive mechanical ventilation undergoing ECCO2 R-plus-RRT treatment were included in the analysis. The treatment allowed to reduce VT from 6.0 ± 0.6 mL/kg at baseline to 4.8 ± 0.8, 4.6 ± 1.0, and 4.3 ± 0.3 mL/kg, driving pressure (ΔP) from 19.8 ± 2.5 cm H2 O to 14.8 ± 3.6, 14.38 ± 4.1 and 10.2 ± 1.6 cm H2 O after 24 hours, 48 hours, and at discontinuation of ECCO2 R-plus-RRT (T3), respectively ( p < 0.001). PaCO2 and pH remained stable. Plasma creatinine decreased over the study period from 3.30 ± 1.27 to 1.90 ± 1.30 and 1.27 ± 0.90 mg/dL after 24 and 48 hours of treatment, respectively ( p < 0.01). No patient-related events associated with the extracorporeal system were reported. These data show that in patients with COVID-19–induced ARDS and AKI, ECCO2 R-plus-RRT is effective in allowing ultraprotective ventilator settings while maintaining an effective support of renal function and values of pH within physiologic limits. Abstract :