The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function

McGuigan, Peter J., Bowcock, Emma M., Barrett, Nicholas A., Blackwood, Bronagh, Boyle, Andrew J., Cadamy, Andrew J., Camporota, Luigi, Conlon, John, Cove, Matthew E., Gillies, Michael A, McDowell, Clíona, McNamee, James J., O'Kane, Cecilia M., Puxty, Alex, Sim, Malcolm, Parsons-Simmonds, Rebecca, Szakmany, Tamas ORCID: https://orcid.org/0000-0003-3632-8844, Young, Neil, Orde, Sam and McAuley, Daniel F. 2024. The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function. Critical Care Explorations 6 (1) , e1028. 10.1097/CCE.0000000000001028

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Abstract

OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO2R) has been investigated as a potential therapy for acute hypoxemic respiratory failure (AHRF) in the pRotective vEntilation with veno-venouS lung assisT in respiratory failure (REST) trial. We investigated the effect of this strategy on cardiac function, and in particular the right ventricle. DESIGN: Substudy of the REST trial. SETTING: Nine U.K. ICUs. PATIENTS: Patients with AHRF (Pao2/Fio2 < 150 mm Hg [20 kPa]). INTERVENTION: Transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were collected at baseline and postrandomization in patients randomized to ECCO2R or usual care. MEASUREMENTS: The primary outcome measures were a difference in tricuspid annular plane systolic excursion (TAPSE) on postrandomization echocardiogram and difference in NT-proBNP postrandomization. RESULTS: There were 21 patients included in the echocardiography cohort (ECCO2R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO2R group compared with the usual care group postrandomization; 3.6 (3.1–4.2) mL/kg PBW versus 5.2 (4.9–5.7) mL/kg PBW, respectively (p = 0.01). There was no difference in the primary outcome measure of mean (sd) TAPSE in the ECCO2R and usual care groups postrandomization; 21.3 (5.4) mm versus 20.1 (3.2) mm, respectively (p = 0.60). There were 75 patients included in the NT-proBNP cohort (ECCO2R, n = 36; usual care, n = 39). Patient characteristics were similar in both groups at baseline. Median (interquartile range [IQR]) tidal volumes were lower in the ECCO2R group than the usual care group postrandomization; 3.8 (3.3–4.2) mL/kg PBW versus 6.7 (5.8–8.1) mL/kg PBW, respectively (p < 0.0001). There was no difference in median (IQR) NT-proBNP postrandomization; 1121 (241–5370) pg/mL versus 1393 (723–4332) pg/mL in the ECCO2R and usual care groups, respectively (p = 0.30). CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO2R, did not modify cardiac function.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	Lippincott, Williams & Wilkins
ISSN:	2639-8028
Date of First Compliant Deposit:	28 March 2024
Date of Acceptance:	1 January 2024
Last Modified:	05 Apr 2024 15:00
URI:	https://orca.cardiff.ac.uk/id/eprint/167612

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