Safety and Efficacy of Combined Extracorporeal CO2 Removal and Renal Replacement Therapy in Patients With Acute Respiratory Distress Syndrome and Acute Kidney Injury

Allardet-Servent, Jérôme; Castanier, Matthias; Signouret, Thomas; Soundaravelou, Rettinavelou; Lepidi, Anne; Seghboyan, Jean-Marie

doi:10.1097/ccm.0000000000001296

Cited by 58 publications

(86 citation statements)

References 42 publications

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“…While ECCO 2 R showed some benefit in a trial including 33 patients and may have aided application of ultraprotective ventilation among ARDS patients [122], another one was terminated due to insufficient CO 2 removal (PROVAP, clincialtrials.gov: NCT03004885). When CRRT is coupled to ECCO 2 R, clinicians should maintain a blood flow > 400 mL/min to ensure adequate CO 2 removal [123] ( Fig. 4).…”

Section: Rationalementioning

confidence: 99%

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

et al. 2019

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Background: Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods:A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion:The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness.

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Section: Rationalementioning

confidence: 99%

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

et al. 2019

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“…Integrating a membrane lung into a continuous renal replacement circuit to deliver ECCO 2 R is an emerging technique. The blood pump and anticoagulation used for continuous renal replacement are sufficient to permit some degree of ECCO 2 R. This setup remains experimental, [32][33][34] and further clinical trials are required.…”

Section: Emerging Experimental Techniquesmentioning

confidence: 99%

Extracorporeal carbon dioxide removal for lowering the risk of mechanical ventilation: research questions and clinical potential for the future

Boyle

Sklar

McNamee

et al. 2018

The Lancet Respiratory Medicine

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 Extracorporeal carbon dioxide removal is an emerging therapy for the treatment of acute respiratory failure.  There is limited evidence to support the routine use of ECCO 2 R, outside of clinical trials, in patients with acute respiratory failure.  Future research should focus on veno-venous ECCO 2 R.  Further research is required to optimise the technology and identify if modifications can be made, especially to permit the use of less anticoagulation than is currently needed.  ECCO 2 R may have a role in facilitating lower tidal volume ventilation than the current standard of care in patients with acute hypoxaemic respiratory failure, but further research is required to confirm this.  In patients with acute hypercapnic respiratory failure, ECCO 2 R may be used to prevent endotracheal intubation, facilitate extubation, and act as an adjunct or alternative to non-invasive ventilation.  Clinicians are encouraged to enroll patients into clinical trials investigating the use of ECCO 2 R in acute respiratory failure, and contribute to data registries.

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“…This first dual renal and pulmonary support platform was described in humans by Forster et al as the “lung‐assisting renal‐replacement system (LARRS)” . Several years later, a prospective observational study was published in France, which also utilized a CVVHD platform and a low flow oxygenator for CO 2 removal . To this date, there is no randomized control trial evaluating this technique in ARDS patients.…”

Section: Discussionmentioning

confidence: 99%

Rescue therapy for hypercapnia due to high PEEP mechanical ventilation in patients with ARDS and renal failure

et al. 2018

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Extracorporeal removal of carbon dioxide in patients experiencing severe hypercapnia due to lung protective mechanical ventilation was first described over four decades ago. There have been many devices developed and described in the interim, many of which require additional training, resources, and staff. This manuscript describes a readily available and relatively simple adjunct that can provide partial lung support in patients with acute respiratory distress syndrome complicated by severe hypercapnia and acute kidney injury requiring dialysis.

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Safety and Efficacy of Combined Extracorporeal CO2 Removal and Renal Replacement Therapy in Patients With Acute Respiratory Distress Syndrome and Acute Kidney Injury

Abstract: Supplemental Digital Content is available in the text.

Cited by 58 publications

References 42 publications

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

Extracorporeal carbon dioxide removal for lowering the risk of mechanical ventilation: research questions and clinical potential for the future

Rescue therapy for hypercapnia due to high PEEP mechanical ventilation in patients with ARDS and renal failure

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