Extracorporeal Co2 Removal in Hypercapnic Patients At Risk of Noninvasive Ventilation Failure: A Matched Cohort Study With Historical Control

被引：130

作者：

Del Sorbo, Lorenzo ^{[1
]}

Pisani, Lara ^{[2
]}

Filippini, Claudia ^{[1
]}

Fanelli, Vito ^{[1
]}

Fasano, Luca ^{[2
]}

Terragni, Pierpaolo ^{[1
]}

Dell'Amore, Andrea ^{[3
]}

Urbino, Rosario ^{[1
]}

Mascia, Luciana ^{[1
]}

Evangelista, Andrea ^{[4
,5
]}

Antro, Camillo ^{[6
]}

D'Amato, Raffaele ^{[1
]}

Sucre, Maria Jose ^{[1
]}

Simonetti, Umberto ^{[1
]}

Persico, Pietro ^{[1
]}

Nava, Stefano ^{[2
]}

Ranieri, V. Marco ^{[1
]}

机构：

[1] Univ Turin, Azienda Osped Citta Salute & Sci Torino, Dipartimento Anestesiol & Rianimaz, Turin, Italy

[2] Alma Mater Univ, St Orsola Malpighi Hosp, Dept Specialist Diagnost & Expt Med DIMES, Resp & Crit Care Unit, Bologna, Italy

[3] Alma Mater Univ, St Orsola Malpighi Hosp, Thorac Surg Unit, Bologna, Italy

[4] Azienda Osped Citta Salute & Sci Torino, Unit Clin Epidemiol, Turin, Italy

[5] CPO Piemonte, Turin, Italy

[6] Univ Turin, Azienda Osped Citta Salute & Sci Torino, Unita Med Urgenza, Dipartimento Emergenza & Accettaz, Turin, Italy

来源：

CRITICAL CARE MEDICINE | 2015年 / 43卷 / 01期

关键词：

acute hypercapnic respiratory failure; chronic obstructive pulmonary disease; extracorporeal Co-2 removal; mechanical ventilation; noninvasive ventilation; respiratory acidosis; OBSTRUCTIVE PULMONARY-DISEASE; CARBON-DIOXIDE REMOVAL; ACUTE RESPIRATORY-FAILURE; POSITIVE-PRESSURE VENTILATION; MECHANICAL VENTILATION; MEMBRANE-OXYGENATION; ACUTE EXACERBATION; CO2; REMOVAL; COPD EXACERBATION; LUNG;

D O I：

10.1097/CCM.0000000000000607

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: To assess efficacy and safety of noninvasive ventilation-plus-extracorporeal Co-2 removal in comparison to noninvasive ventilation-only to prevent endotracheal intubation patients with acute hypercapnic respiratory failure at risk of failing noninvasive ventilation. Design: Matched cohort study with historical control. Setting: Two academic Italian ICUs. Patients: Patients treated with noninvasive ventilation for acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease (May 2011 to November 2013). Interventions: Extracorporeal Co-2 removal was added to noninvasive ventilation when noninvasive ventilation was at risk of failure (arterial pH <= 7.30 with arterial Pco(2) > 20% of baseline, and respiratory rate >= 30 breaths/min or use of accessory muscles/paradoxical abdominal movements). The noninvasive ventilation-only group was created applying the genetic matching technique (GenMatch) on a dataset including patients enrolled in two previous studies. Exclusion criteria for both groups were mean arterial pressure less than 60 mm Hg, contraindications to anticoagulation, body weight greater than 120 kg, contraindication to continuation of active treatment, and failure to obtain consent. Measurements and Main Results: Primary endpoint was the cumulative prevalence of endotracheal intubation. Twenty-five patients were included in the noninvasive ventilation-plus-extracorporeal Co-2 removal group. The GenMatch identified 21 patients for the noninvasive ventilation-only group. Risk of being intubated was three times higher in patients treated with noninvasive ventilation-only than in patients treated with noninvasive ventilation-plus-extracorporeal Co-2 removal (hazard ratio, 0.27; 95% CI, 0.07-0.98; p = 0.047). Intubation rate in noninvasive ventilation-plus-extracorporeal Co-2 removal was 12% (95% CI, 2.5-31.2) and in noninvasive ventilation-only was 33% (95% CI, 14.6-57.0), but the difference was not statistically different (p = 0.1495). Thirteen patients (52%) experienced adverse events related to extracorporeal Co-2 removal. Bleeding episodes were observed in three patients, and one patient experienced vein perforation. Malfunctioning of the system caused all other adverse events. Conclusions: These data provide the rationale for future randomized clinical trials that are required to validate extracorporeal Co-2 removal in patients with hypercapnic respiratory failure and respiratory acidosis nonresponsive to noninvasive ventilation.

引用

页码：120 / 127

页数：8

共 35 条

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