Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome
Coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Ext...
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2020.598379/full |
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| author | Faeq Husain-Syed Faeq Husain-Syed Faeq Husain-Syed Horst-Walter Birk Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Claudio Ronco Claudio Ronco V. Marco Ranieri Bianka Karle Stefan Kuhnert Khodr Tello Khodr Tello Khodr Tello Matthias Hecker Matthias Hecker Rory E. Morty Rory E. Morty Rory E. Morty Rory E. Morty Susanne Herold Susanne Herold Susanne Herold Oliver Kehl Hans-Dieter Walmrath Hans-Dieter Walmrath Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger István Vadász István Vadász István Vadász |
| author_facet | Faeq Husain-Syed Faeq Husain-Syed Faeq Husain-Syed Horst-Walter Birk Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Claudio Ronco Claudio Ronco V. Marco Ranieri Bianka Karle Stefan Kuhnert Khodr Tello Khodr Tello Khodr Tello Matthias Hecker Matthias Hecker Rory E. Morty Rory E. Morty Rory E. Morty Rory E. Morty Susanne Herold Susanne Herold Susanne Herold Oliver Kehl Hans-Dieter Walmrath Hans-Dieter Walmrath Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger István Vadász István Vadász István Vadász |
| author_sort | Faeq Husain-Syed |
| collection | DOAJ |
| description | Coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Extracorporeal carbon dioxide removal (ECCO2R) has been proposed as an adjuvant therapy to avoid progression of clinical severity and limit further ventilator-induced lung injury, but its use in COVID-19 has not been described yet. Acute kidney injury requiring renal replacement therapy (RRT) is common among critically ill COVID-19 patients. In centers with available dialysis, low-flow ECCO2R (<500 mL/min) using RRT platforms could be carried out by dialysis specialists and might be an option to efficiently allocate resources during the COVID-19 pandemic for patients with hypercapnia as the main indication. Here, we report the feasibility, safety, and efficacy of ECCO2R using an RRT platform to provide either standalone ECCO2R or ECCO2R combined with RRT in four hypercapnic patients with moderate ARDS. A randomized clinical trial is required to assess the overall benefit and harm.Clinical Trial Registration:ClinicalTrials.gov. Unique identifier: NCT04351906. |
| first_indexed | 2024-12-13T05:16:22Z |
| format | Article |
| id | doaj.art-150cea2a4dbb40d49aa6a06919dffe64 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-13T05:16:22Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-150cea2a4dbb40d49aa6a06919dffe642022-12-21T23:58:25ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-11-01710.3389/fmed.2020.598379598379Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress SyndromeFaeq Husain-Syed0Faeq Husain-Syed1Faeq Husain-Syed2Horst-Walter Birk3Jochen Wilhelm4Jochen Wilhelm5Jochen Wilhelm6Jochen Wilhelm7Claudio Ronco8Claudio Ronco9V. Marco Ranieri10Bianka Karle11Stefan Kuhnert12Khodr Tello13Khodr Tello14Khodr Tello15Matthias Hecker16Matthias Hecker17Rory E. Morty18Rory E. Morty19Rory E. Morty20Rory E. Morty21Susanne Herold22Susanne Herold23Susanne Herold24Oliver Kehl25Hans-Dieter Walmrath26Hans-Dieter Walmrath27Werner Seeger28Werner Seeger29Werner Seeger30Werner Seeger31Werner Seeger32Werner Seeger33István Vadász34István Vadász35István Vadász36Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyInternational Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, ItalyDivison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyInstitute for Lung Health, Justus Liebig University Giessen, Giessen, GermanyInternational Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, ItalyDepartment of Medicine (DIMED), Università di Padova, Padua, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Anaesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, ItalyDivison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyDepartment of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyDivison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyInstitute for Lung Health, Justus Liebig University Giessen, Giessen, GermanyDepartment of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, GermanyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, GermanyUniversities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, GermanyThe Cardio-Pulmonary Institute, Giessen, GermanyCoronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Extracorporeal carbon dioxide removal (ECCO2R) has been proposed as an adjuvant therapy to avoid progression of clinical severity and limit further ventilator-induced lung injury, but its use in COVID-19 has not been described yet. Acute kidney injury requiring renal replacement therapy (RRT) is common among critically ill COVID-19 patients. In centers with available dialysis, low-flow ECCO2R (<500 mL/min) using RRT platforms could be carried out by dialysis specialists and might be an option to efficiently allocate resources during the COVID-19 pandemic for patients with hypercapnia as the main indication. Here, we report the feasibility, safety, and efficacy of ECCO2R using an RRT platform to provide either standalone ECCO2R or ECCO2R combined with RRT in four hypercapnic patients with moderate ARDS. A randomized clinical trial is required to assess the overall benefit and harm.Clinical Trial Registration:ClinicalTrials.gov. Unique identifier: NCT04351906.https://www.frontiersin.org/articles/10.3389/fmed.2020.598379/fullcontinuous renal replacement therapyrespiratory acidosisSARS-CoV-2extracorporeal organ supportrespiratory dialysis |
| spellingShingle | Faeq Husain-Syed Faeq Husain-Syed Faeq Husain-Syed Horst-Walter Birk Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Jochen Wilhelm Claudio Ronco Claudio Ronco V. Marco Ranieri Bianka Karle Stefan Kuhnert Khodr Tello Khodr Tello Khodr Tello Matthias Hecker Matthias Hecker Rory E. Morty Rory E. Morty Rory E. Morty Rory E. Morty Susanne Herold Susanne Herold Susanne Herold Oliver Kehl Hans-Dieter Walmrath Hans-Dieter Walmrath Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger Werner Seeger István Vadász István Vadász István Vadász Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome Frontiers in Medicine continuous renal replacement therapy respiratory acidosis SARS-CoV-2 extracorporeal organ support respiratory dialysis |
| title | Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome |
| title_full | Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome |
| title_fullStr | Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome |
| title_short | Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome |
| title_sort | extracorporeal carbon dioxide removal using a renal replacement therapy platform to enhance lung protective ventilation in hypercapnic patients with coronavirus disease 2019 associated acute respiratory distress syndrome |
| topic | continuous renal replacement therapy respiratory acidosis SARS-CoV-2 extracorporeal organ support respiratory dialysis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2020.598379/full |
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