Although mechanical ventilation remains the cornerstone of ARDS treatment, several experimental and clinical studies have undoubtedly demonstrated that it can contribute to high mortality through the developing of ventilator induced lung injury even in patients with plateau pressure \<30 cmH2O. Since now there are no studies exploring the application of low flow extracorporeal CO2 removal and ultraprotective ventilation to reduce mechanical power, a composite index of VILI, independently from the value of plateau pressure or the severity of hypercapnia.
Study Type
OBSERVATIONAL
Enrollment
15
Extracorporeal carbon dioxide removal (ECCO2R), a low flow extracorporeal CO2 removal, may be used in association with ultraprotective mechanical ventilation (tidal volume \< 6 ml/kg and Pplat \<20-25 cmH2O).
ASST-Santi Paolo e Carlo, San Paolo Hospital
Milan, Italy
RECRUITINGMechanical Power reduction.
Achievement of Mechanical Power reduction under 18 J/min while maintaining pH and PaCO2 to ± 20% of baseline values obtained at tidal volume of 6 mL/kg. Mechanical Power (MP) (J/min) = 0.098 \* respiratory rate \* tidal volume (inspiratory peak airway pressure - 1/2 \* (airway pressure at end inspiratory pause - airway pressure at PEEP))
Time frame: Changes from baseline to day 5.
Respiratory mechanics.
1\. Respiratory system elastance (Ers) (cmH2O/L) = (airway pressure at end inspiratory pause - airway pressure at PEEP) / tidal volume
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Respiratory mechanics.
2\. Lung elastance (El) (cmH2O/L) = (transpulmonary pressure at end inspiratory pause - transpulmonary pressure at PEEP / tidal volume
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Respiratory mechanics.
3\. Chest wall elastance (Ecw) (cmH2O/L) = (esophageal pressure at end inspiratory pause - esophageal pressure at PEEP) / tidal volume
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Respiratory mechanics.
4\. End inspiratory transpulmonary pressure (cmH2O)= airway pressure at end inspiratory pause - (esophageal pressure at end inspiratory pause - expiration at atmospheric pressure by a release manouvre).
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Gas exchange.
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Assessment of changes in PaCO2 mmHg.
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Gas exchange.
Assessment of changes in PaO2 mmHg.
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Gas exchange.
Assessment of changes in PaO2/FiO2.
Time frame: Every six hours, every day until the fifth day or until the weaning from ECCO2R if lower than five days
Safety assessment and adverse device related events: frequency of serious adverse events
Safety assessment reporting frequency of serious adverse events in terms of device related mechanical events (Pump malfunction, membrane lung clotting, system leaks, tubing rupture, air in the circuit) and device related clinical events (heamolysis, significant bleeding, thromboembolic complications, neurologic complications, metabolic complications).
Time frame: Every day, until the fifth day or until the weaning from ECCO2R if lower than five days