PMID- 38213419 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240113 IS - 2639-8028 (Electronic) IS - 2639-8028 (Linking) VI - 6 IP - 1 DP - 2024 Jan TI - The Effect of Lower Tidal Volume Ventilation Facilitated by Extracorporeal Carbon Dioxide Removal Compared With Conventional Lung Protective Ventilation on Cardiac Function. PG - e1028 LID - 10.1097/CCE.0000000000001028 [doi] LID - e1028 AB - OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO(2)R) 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 (Pao(2)/Fio(2) < 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 ECCO(2)R 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 (ECCO(2)R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO(2)R 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 ECCO(2)R 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 (ECCO(2)R, 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 ECCO(2)R 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 ECCO(2)R and usual care groups, respectively (p = 0.30). CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO(2)R, did not modify cardiac function. CI - Copyright (c) 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. FAU - McGuigan, Peter J AU - McGuigan PJ AD - Royal Victoria Hospital, Belfast, United Kingdom. AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. FAU - Bowcock, Emma M AU - Bowcock EM AD - Nepean Hospital, Sydney, Australia. AD - University of Sydney, Sydney, Australia. FAU - Barrett, Nicholas A AU - Barrett NA AD - Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. AD - Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom. FAU - Blackwood, Bronagh AU - Blackwood B AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. FAU - Boyle, Andrew J AU - Boyle AJ AD - Royal Victoria Hospital, Belfast, United Kingdom. AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. FAU - Cadamy, Andrew J AU - Cadamy AJ AD - Queen Elizabeth University Hospital, Glasgow, United Kingdom. AD - School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom. FAU - Camporota, Luigi AU - Camporota L AD - Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. AD - Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom. FAU - Conlon, John AU - Conlon J AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. FAU - Cove, Matthew E AU - Cove ME AD - National University Hospital, Singapore, Singapore. FAU - Gillies, Michael A AU - Gillies MA AD - Edinburgh Royal Infirmary, Edinburgh, United Kingdom. FAU - McDowell, Cliona AU - McDowell C AD - Northern Ireland Clinical Trials Unit, Belfast, United Kingdom. FAU - McNamee, James J AU - McNamee JJ AD - Royal Victoria Hospital, Belfast, United Kingdom. FAU - O'Kane, Cecilia M AU - O'Kane CM AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. FAU - Puxty, Alex AU - Puxty A AD - Glasgow Royal Infirmary, Glasgow, United Kingdom. FAU - Sim, Malcolm AU - Sim M AD - Queen Elizabeth University Hospital, Glasgow, United Kingdom. FAU - Parsons-Simmonds, Rebecca AU - Parsons-Simmonds R AD - University Hospital of Wales, Cardiff, United Kingdom. FAU - Szakmany, Tamas AU - Szakmany T AD - Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, United Kingdom. AD - Department of Anaesthesia Intensive Care and Pain Medicine, Cardiff University, Cardiff, United Kingdom. FAU - Young, Neil AU - Young N AD - Edinburgh Royal Infirmary, Edinburgh, United Kingdom. FAU - Orde, Sam AU - Orde S AD - Nepean Hospital, Sydney, Australia. AD - University of Sydney, Sydney, Australia. FAU - McAuley, Daniel F AU - McAuley DF AD - Royal Victoria Hospital, Belfast, United Kingdom. AD - Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom. LA - eng PT - Journal Article DEP - 20240110 PL - United States TA - Crit Care Explor JT - Critical care explorations JID - 101746347 PMC - PMC10783412 OTO - NOTNLM OT - N-terminal pro-B-type natriuretic peptide OT - acute hypoxemic respiratory failure OT - echocardiography OT - extracorporeal circulation OT - right ventricle COIS- Dr. McGuigan is funded by Belfast Health and Social Care Trust, Research Charitable Funds (reference J-2223-152). The funding body had no role in the design of the study, collection, analysis, and interpretation of data or in writing the article. Dr. Boyle reported receiving grants from the Northern Ireland Health and Social Care Research and Development Agency to undertake a sampling substudy within a clinical trial of extracorporeal carbon dioxide removal. Dr. McNamee reported receiving grants from the National Institute for Health Research Health Technology Assessment Programme during the conduct of the study and speaking fees from Baxter outside the submitted work. Dr. Szakmany is associate editor for social media, Critical Care Explorations and the Journal of the Intensive Care Society. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2024/01/12 06:42 MHDA- 2024/01/12 06:43 PMCR- 2024/01/10 CRDT- 2024/01/12 03:39 PHST- 2024/01/12 06:43 [medline] PHST- 2024/01/12 06:42 [pubmed] PHST- 2024/01/12 03:39 [entrez] PHST- 2024/01/10 00:00 [pmc-release] AID - 10.1097/CCE.0000000000001028 [doi] PST - epublish SO - Crit Care Explor. 2024 Jan 10;6(1):e1028. doi: 10.1097/CCE.0000000000001028. eCollection 2024 Jan.