The objective of this study is to assess the efficacy and safety of this new Prismalung+ membrane in its intended clinical setting by demonstrating a reduction in ventilatory parameters and pulmonary energy load or the successful maintenance of spontaneous breathing, respectively, the absence of the need to initiate vv-ECMO therapy, and initial survival.
Our hypotheses are that decarboxylation therapy by means of the novel Prismalung+ membrane in patients with hypercapnic respiratory failure (I) allows the reduction of tidal volume, peak airway pressure, dP and pulmonary energy load (as measured by AUC over 72 hours) as compared to baseline in mechanically ventilated patients OR is associated with successful continuation of spontaneous breathing despite respiratory exhaustion (no decision to intubate), and that these patients (II) warrant no decision to initiate vv-ECMO therapy and (III) do not experience early mortality. The primary Objectives of the study are to test our hypotheses I to III by applying the novel Prismalung+ ECCO2R device in mechanically ventilated patients and spontaneously breathing patients experiencing hypercapnic respiratory failure in a multi-central prospective trial in three experienced intensive care units in Switzerland.
Study Type
OBSERVATIONAL
Enrollment
60
Low-flow extracorporeal CO2 removal with or without concurrent continuous renal replacement therapy
Kantonsspital St. Gallen
Sankt Gallen, Switzerland
RECRUITINGTidal volume
Tidal volume (VT \[mL/kg\]) in mechanically ventilated patients or no intubation in spontaneously breathing patients
Time frame: At timepoint 1 (72 hours)
Peak Pressure
Peak Pressure (Ppeak \[mbar\]) in mechanically ventilated patients or no intubation in spontaneously breathing patients
Time frame: At timepoint 1 (72 hours)
Driving Pressure
Driving Pressure \[mbar\] in mechanically ventilated patients or no intubation in spontaneously breathing patients
Time frame: At timepoint 1 (72 hours)
VV-ECMO therapy
No initiation of VV-ECMO therapy
Time frame: At timepoint 2 (28 days)
Survival
Survival
Time frame: At timepoint 2 (28 days)
Secondary endpoint - respiratory mechanics
Reduction in pulmonary energy load after initiation of ECCO2R as compared to baseline in mechanically ventilated patients
Time frame: 72 hours
Secondary endpoint - complications
Incidence of complications such as bleeding, thrombosis, coagulatory activation as evidences by thrombocytopenia, elevated D-Dimer levels, and plasmatic coagulatory failure.
Time frame: 28 days
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