Ultra-protective Pulmonary Ventilation Supported by Low Flow ECCO2R for Severe ARDS

Launched by NATIONAL UNIVERSITY HEALTH SYSTEM, SINGAPORE · Sep 26, 2014

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ClinConnect Summary

Current best practices for management of severe ARDS include lung protective ventilation and nursing in the prone position. However, the best lung protective strategy is not currently established and using smaller ventilation volumes than standard lung protective ventilation suggest lung recovery is improved.

Application of smaller ventilation volumes requires extracorporeal carbon dioxide removal, using a device similar to a dialysis to remove carbon dioxide directly from the blood. One such device in the Prismalung, it removes blood through a catheter, much like a dialysis catheter, pump...

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Eligibility criteria

• Inclusion Criteria:
• • Admitted to MICU with respiratory failure and intubated
• • ARDS criteria per Berlin definition
• • PaO2:FiO2 ratio ≤ 200 mmHg for \> 6 hours with FiO2 ≥0.5
• • Expected to require mechanical ventilation for \>48 hours
• • Reversible disease
• Exclusion Criteria:
• • Anticoagulation contraindicated
• • Proven HIT
• • Unable to obtain central venous access
• • Refractory hypoxia (PaO2:FiO2 ≤80 after recruitment and proning) or other indication for ECMO
• • Home oxygen use
• • Severe COPD
• • Interstitial lung disease
• • \> 7 days of mechanical ventilation
• • Immunocompromised patient (bone marrow, untreated HIV, PJP)
• • Advanced malignancy with life expectancy ≤ 6months