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Extracorporeal CO2 Removal During Renal Replacement Therapy to Allow Lung-Protective Ventilation in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome.
Alessandri, Francesco; Tonetti, Tommaso; Pistidda, Laura; Busani, Stefano; Borrazzo, Cristian; Fanelli, Vito; Polzoni, Mauro; Piazza, Ornella; Lorini, Luca; Cattaneo, Sergio; Ricci, Davide; Zanoni, Andrea; Girardis, Massimo; Terragni, Pierpaolo; Tempesta, Michele; Di Luca, Marina; Pugliese, Francesco; Ranieri, V Marco.
  • Alessandri F; From the Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
  • Tonetti T; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
  • Pistidda L; Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy.
  • Busani S; Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
  • Borrazzo C; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
  • Fanelli V; From the Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
  • Polzoni M; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
  • Piazza O; Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy.
  • Lorini L; Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
  • Cattaneo S; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
  • Ricci D; Department of Anaesthesia, Critical Care and Emergency-Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy.
  • Zanoni A; Dipartimento di Emergenza Urgenza Ospedale Sant'Eugenio, Rome, Italy.
  • Girardis M; Department of Medicine, Surgery, Dentistry, University of Salerno, Fisciano, Italy.
  • Terragni P; Department Emergency and Critical Area, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Tempesta M; Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Spedali Civili University Hospital, Brescia, Italy.
  • Di Luca M; Dipartimento di Emergenza Urgenza, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.
  • Pugliese F; UO Nefrologia e Dialisi-Az Osp. Ospedali Riuniti Marche Nord, Pesaro, Italy.
  • Ranieri VM; Dipartimento di Emergenza Urgenza Ospedale Sant'Eugenio, Rome, Italy.
ASAIO J ; 2022 Aug 23.
Article in English | MEDLINE | ID: covidwho-2227279
ABSTRACT
The aim of this retrospective multicenter observational study is to test the feasibility and safety of a combined extracorporeal CO2 removal (ECCO2R) plus renal replacement therapy (RRT) system to use an ultraprotective ventilator setting while maintaining (1) an effective support of renal function and (2) values of pH within the physiologic limits in a cohort of coronavirus infectious disease 2019 (COVID-19) patients. Among COVID-19 patients admitted to the intensive care unit of 9 participating hospitals, 27 patients with acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) requiring invasive mechanical ventilation undergoing ECCO2R-plus-RRT treatment were included in the analysis. The treatment allowed to reduce VT from 6.0 ± 0.6 mL/kg at baseline to 4.8 ± 0.8, 4.6 ± 1.0, and 4.3 ± 0.3 mL/kg, driving pressure (ΔP) from 19.8 ± 2.5 cm H2O to 14.8 ± 3.6, 14.38 ± 4.1 and 10.2 ± 1.6 cm H2O after 24 hours, 48 hours, and at discontinuation of ECCO2R-plus-RRT (T3), respectively (p < 0.001). PaCO2 and pH remained stable. Plasma creatinine decreased over the study period from 3.30 ± 1.27 to 1.90 ± 1.30 and 1.27 ± 0.90 mg/dL after 24 and 48 hours of treatment, respectively (p < 0.01). No patient-related events associated with the extracorporeal system were reported. These data show that in patients with COVID-19-induced ARDS and AKI, ECCO2R-plus-RRT is effective in allowing ultraprotective ventilator settings while maintaining an effective support of renal function and values of pH within physiologic limits.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal subject: Transplantation Year: 2022 Document Type: Article Affiliation country: MAT.0000000000001803

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal subject: Transplantation Year: 2022 Document Type: Article Affiliation country: MAT.0000000000001803