Feasibility and safety of ultra-low volume ventilation (≤ 3 ml/kg) combined with extra corporeal carbon dioxide removal (ECCO2R) in acute respiratory failure patients
Clément Monet, Thomas Renault, Yassir Aarab, Joris Pensier, Albert Prades, Inès Lakbar, Clément Le Bihan, Mathieu Capdevila, Audrey De Jong, Nicolas Molinari, Samir Jaber
Abstract
Ultra-protective ventilation is the combination of low airway pressures and tidal volume (Vt) combined with extra corporeal carbon dioxide removal (ECCO 2 R). A recent large study showed no benefit of ultra-protective ventilation compared to standard ventilation in ARDS (Acute Respiratory Distress Syndrome) patients. However, the reduction in Vt failed to achieve the objective of less than or equal to 3 ml/kg predicted body weight (PBW). The main objective of our study was to assess the feasibility of the ultra-low volume ventilation (Vt ≤ 3 ml/kg PBW) facilitated by ECCO 2 R in acute respiratory failure patients. Retrospective analysis of a prospective cohort of patients with either high or low blood flow veno-venous ECCO 2 R devices. A session was defined as a treatment of ECCO 2 R from the start to the removal of the device (one patient could have one more than one session). Primary endpoint was the proportion of sessions during which a Vt less or equal to 3 ml/kg PBW at 24 h after the start of ECCO 2 R was successfully achieved for at least 12 h. Secondary endpoints were respiratory variables, rate of adverse events and outcomes. Forty-five ECCO 2 R sessions were recorded among 41 patients. Ultra-low volume ventilation (tidal volume ≤ 3 ml/kg PBW, success group) was successfully achieved at 24 h in 40.0% sessions (18 out of 45 sessions, confidence interval 25.3–54.6%). At 24 h, tidal volume in the failure group was 4.1 [3.8–4.5] ml/kg PBW compared to 2.1 [1.9–2.5] in the success group ( p < 0.001). After multivariate analysis, blood flow rate was significantly associated with success of ultra-low volume ventilation (adjusted OR per 100 ml/min increase 1.51 (95%CI 1.21–1.90, p = 0.0003). Ultra-low volume ventilation (≤ 3 ml/kg PBW) was feasible in 18 out of 45 sessions. Higher blood flow rates were associated with the success of ultra-low volume ventilation.