Feasibility and safety of ultra-low tidal volume ventilation without extracorporeal circulation in moderately severe and severe ARDS patients

Purpose Mechanical ventilation with ultra-low tidal volume (VT) during ARDS may reduce alveolar strain, driving pressure and hence ventilator-induced lung injury, with the main drawback of worsening respiratory acidosis. We hypothesized that VT could be reduced down to 4 ml/kg, with clinically significant decrease in driving pressure, without the need for extracorporeal $ CO_{2} $ removal, while maintaining pH > 7.20. Methods We conducted a non-experimental before-and-after multicenter study on 35 ARDS patients with $ PaO_{2} $/$ FiO_{2} $ ≤ 150 mmHg, within 24 h of ARDS diagnosis. After inclusion, VT was reduced to 4 ml/kg and further adjusted to maintain pH ≥ 7.20, respiratory rate was increased up to 40 $ min^{−1} $ and PEEP was set using a PEEP–$ FiO_{2} $ table. The primary judgment criterion was driving pressure on day 2 of the study, as compared to inclusion. Results From inclusion to day 2, driving pressure decreased significantly from 12 [9–15] to 8 [6–11] $ cmH_{2} $O, while VT decreased from 6.0 [5.9–6.1] to 4.1 [4.0–4.7] ml/kg. On day 2, VT was below 4.2 ml/kg in 65% [$ CI_{95%} $ 48%–79%], and below 5.25 ml/kg in 88% [$ CI_{95%} $ 74%–95%] of the patients. 2 patients (6%) developed acute cor pulmonale after inclusion. Eleven patients (32%) developed transient severe acidosis with pH < 7.15. Fourteen patients (41%) died before day 90. Conclusion Ultra-low tidal volume ventilation may be applied in approximately 2/3 of moderately severe-to-severe ARDS patients, with a 4 $ cmH_{2} $O median reduction in driving pressure, at the price of transient episodes of severe acidosis in approximately 1/3 of the patients..

Medienart:

E-Artikel

Erscheinungsjahr:

2019

Erschienen:

2019

Enthalten in:

Zur Gesamtaufnahme - volume:45

Enthalten in:

Intensive care medicine - 45(2019), 11 vom: 23. Sept., Seite 1590-1598

Sprache:

Englisch

Beteiligte Personen:

Richard, J. C. [VerfasserIn]
Marque, S. [VerfasserIn]
Gros, A. [VerfasserIn]
Muller, M. [VerfasserIn]
Prat, G. [VerfasserIn]
Beduneau, G. [VerfasserIn]
Quenot, J. P. [VerfasserIn]
Dellamonica, J. [VerfasserIn]
Tapponnier, R. [VerfasserIn]
Soum, E. [VerfasserIn]
Bitker, L. [VerfasserIn]
Richecoeur, J. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.69$jIntensivmedizin

Themen:

Acute respiratory distress syndrome
Driving pressure
ECCO2R, ultraprotective ventilation
ECMO
Permissive hypercapnia

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

doi:

10.1007/s00134-019-05776-x

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2096954525

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