Adult Respiratory Distress Syndrome
Conditions
Keywords
Respiratory Insufficiency, CO2 removal, protective ventilation, ARDS
Brief summary
30% of ARDS patients ventilated according to NIH protocol presents morphological (CT) and functional (Stress Index\>1) conditions of hyperinflation even with Plateau pressure (Pplat) \< 30 cmH2O; values of Pplat lower than 26 cmH2O were associated with more a condition of more protective ventilation. In patients at risk of hyperinflation, use of alternative techniques such as CO2-removal my allow the reduction of Tidal Volume (Vt) and Pplat.
Detailed description
Aim of the study was to verify the efficacy of CO2-removal technique in reducing Vt and consequently Pplat to obtain a Stress Index value equal to 1.
Interventions
PROCEDUREprotective ventilation with CO2 removal technique
In ARDS patients, presenting a Pplat ≥ 26 cmH2O, Vt was lowered (reaching a Pplat \< 26) with CO2-removal veno-venous pump-driven bypass support for 48 consecutive hours with a pH \> 7,30 or at least 72 hours from the beginning of the extracorporeal treatment.
Sponsors
Regione Piemonte
University of Turin, Italy
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* ARDS patients with Pplat \>= 26 during NIH protective ventilation protocol
Exclusion criteria
* Age \< 18 years * Brain injury and patients with intracranial pressure \> 20 mmHg * Pregnancy * Immunodepressed patients * Patients already enrolled in other trials * Renal replacement therapy * BMI \> 40 * Contraindication anticoagulation treatment * Morphological abnormalities of femoral veins * NYHA III-IV * Burns BSA\>30% * Hepatic failure (grade C Child)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| pulmonary inflammatory mediator reduction | within the first 72 hours after enrollment |
Countries
Italy
Outcome results
None listed