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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.
Husain-Syed, Faeq; Birk, Horst-Walter; Wilhelm, Jochen; Ronco, Claudio; Ranieri, V Marco; Karle, Bianka; Kuhnert, Stefan; Tello, Khodr; Hecker, Matthias; Morty, Rory E; Herold, Susanne; Kehl, Oliver; Walmrath, Hans-Dieter; Seeger, Werner; Vadász, István.
  • Husain-Syed F; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Birk HW; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Wilhelm J; International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.
  • Ronco C; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Ranieri VM; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Karle B; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.
  • Kuhnert S; The Cardio-Pulmonary Institute, Giessen, Germany.
  • Tello K; Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany.
  • Hecker M; International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.
  • Morty RE; Department of Medicine (DIMED), Università di Padova, Padua, Italy.
  • Herold S; Department of Medical and Surgical Sciences (DIMEC), Anaesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Kehl O; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Walmrath HD; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Seeger W; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Vadász I; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.
Front Med (Lausanne) ; 7: 598379, 2020.
Article in English | MEDLINE | ID: covidwho-954188
Semantic information from SemMedBD (by NLM)
1. Hypercapnia PROCESS_OF Patients
Subject
Hypercapnia
Predicate
PROCESS_OF
Object
Patients
2. Assisted breathing TREATS Hypercapnia
Subject
Assisted breathing
Predicate
TREATS
Object
Hypercapnia
3. Assisted breathing TREATS Respiratory Distress Syndrom
Subject
Assisted breathing
Predicate
TREATS
Object
Respiratory Distress Syndrom
4. Respiratory Distress Syndrom PROCESS_OF C0030705
Subject
Respiratory Distress Syndrom
Predicate
PROCESS_OF
Object
C0030705
5. Assisted breathing TREATS Patients
Subject
Assisted breathing
Predicate
TREATS
Object
Patients
6. Ventilator-Induced Lung Injury COEXISTS_WITH COVID-19
Subject
Ventilator-Induced Lung Injury
Predicate
COEXISTS_WITH
Object
COVID-19
7. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
8. Kidney Failur PROCESS_OF C0030705
Subject
Kidney Failur
Predicate
PROCESS_OF
Object
C0030705
9. Renal Replacement Therapy TREATS Hypercapnia
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Hypercapnia
10. Renal Replacement Therapy TREATS Respiratory Distress Syndrom
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Respiratory Distress Syndrom
11. Renal Replacement Therapy TREATS Patients
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Patients
12. Hypercapnia PROCESS_OF Patients
Subject
Hypercapnia
Predicate
PROCESS_OF
Object
Patients
13. Assisted breathing TREATS Hypercapnia
Subject
Assisted breathing
Predicate
TREATS
Object
Hypercapnia
14. Assisted breathing TREATS Respiratory Distress Syndrome, Adult
Subject
Assisted breathing
Predicate
TREATS
Object
Respiratory Distress Syndrome, Adult
15. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
Subject
Respiratory Distress Syndrome, Adult
Predicate
PROCESS_OF
Object
Patients
16. Assisted breathing TREATS Patients
Subject
Assisted breathing
Predicate
TREATS
Object
Patients
17. Ventilator-Induced Lung Injury COEXISTS_WITH COVID-19
Subject
Ventilator-Induced Lung Injury
Predicate
COEXISTS_WITH
Object
COVID-19
18. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
19. Kidney Failure, Acute PROCESS_OF Patients
Subject
Kidney Failure, Acute
Predicate
PROCESS_OF
Object
Patients
20. Renal Replacement Therapy TREATS Hypercapnia
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Hypercapnia
21. Renal Replacement Therapy TREATS Respiratory Distress Syndrome, Adult
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Respiratory Distress Syndrome, Adult
22. Renal Replacement Therapy TREATS Patients
Subject
Renal Replacement Therapy
Predicate
TREATS
Object
Patients
ABSTRACT
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.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Controlled clinical trial / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2020 Document Type: Article Affiliation country: Fmed.2020.598379

Full text: Available Collection: International databases Database: MEDLINE Type of study: Controlled clinical trial / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2020 Document Type: Article Affiliation country: Fmed.2020.598379