Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study.
Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study.
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DOI：
10.1007/s00134-012-2787-6
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发表时间：
2013-05
影响因子：
38.9
通讯作者：
Slutsky, Arthur S.
中科院分区：
文献类型：
--
作者：
Bein, Thomas;Weber-Carstens, Steffen;Goldmann, Anton;Mueller, Thomas;Staudinger, Thomas;Brederlau, Joerg;Muellenbach, Ralf;Dembinski, Rolf;Graf, Bernhard M.;Wewalka, Marlene;Philipp, Alois;Wernecke, Klaus-Dieter;Lubnow, Matthias;Slutsky, Arthur S.
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急性呼吸窘迫综合征的特征在于由各种损伤引起的肺损伤，包括通气本身，并且潮气过度充气可导致呼吸机诱导的肺损伤（VILI）。我们研究了低潮气量（VT）策略（VT ≤ 3 ml/kg/预计体重[PBW]）使用无泵体外肺辅助治疗已建立的ARDS的效果。79名患者在“稳定期”（24小时优化治疗和高PEEP）后入组。他们被随机分配接受低VT通气（103 ml/kg）联合体外CO2清除，或接受ARDSNet策略（106 ml/kg），不使用体外装置。主要结局是28天和60天无呼吸机日（VFD）。次要结局参数为呼吸力学、气体交换、镇痛/镇静剂使用、并发症和住院死亡率。非常低V T的通气很容易与体外CO2去除一起实施。60天内的VFD在研究组之间没有差异（33.2 ± 20）例，对照组（29.2 ± 21，p = 0.469），但在更多低氧血症患者中（PaO 2/FIO 2 ≤150）事后分析表明，研究患者的VFD-60显著改善（40.9 ± 12.8）与对照组（28.2 ± 16.4，p = 0.033）相比。死亡率较低（16.5%），组间无差异。与“正常”肺保护管理相比，使用极低VT结合体外CO2清除有可能进一步降低VILI。该策略是否会改善ARDS患者的生存率仍有待确定（临床试验NCT 00538928）。本文的在线版本（doi：10.1007/s 00134 -012-2787-6）包含补充材料，可供授权用户使用。
Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V T) strategy (V T ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Seventy-nine patients were enrolled after a ‘stabilization period’ (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V T ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (≈6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality. Ventilation with very low V T’s was easy to implement with extracorporeal CO2-removal. VFD’s within 60 days were not different between the study group (33.2 ± 20) and the control group (29.2 ± 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 ≤150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 ± 12.8) compared to control (28.2 ± 16.4, p = 0.033). The mortality rate was low (16.5 %) and did not differ between groups. The use of very low V T combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a ‘normal’ lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928). The online version of this article (doi:10.1007/s00134-012-2787-6) contains supplementary material, which is available to authorized users.
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DOI：
10.1186/cc8213
发表时间：
2009
期刊：
Critical care (London, England)
影响因子：
--
作者：
Müller T;Philipp A;Luchner A;Karagiannidis C;Bein T;Hilker M;Rupprecht L;Langgartner J;Zimmermann M;Arlt M;Wenger J;Schmid C;Riegger GA;Pfeifer M;Lubnow M
通讯作者：
Lubnow M
DOI：
10.1164/rccm.200710-1589oc
发表时间：
2008-08-15
影响因子：
24.7
作者：
Chiumello, Davide;Carlesso, Eleonora;Gattinoni, Luciano
通讯作者：
Gattinoni, Luciano
影响因子：
8.8
作者：
Rubenfeld, GD;Cooper, C;Hudson, LD
通讯作者：
Hudson, LD
影响因子：
8.8
作者：
Terragni, Pier Paolo;Del Sorbo, Lorenzo;Ranieri, V. Marco
通讯作者：
Ranieri, V. Marco
DOI：
10.1164/rccm.200607-915oc
发表时间：
2007-01-15
影响因子：
24.7
作者：
Terragni, Pier Paolo;Rosboch, Giulio;Ranieri, V. Marco
通讯作者：
Ranieri, V. Marco