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Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial.
Duggal, Abhijit; Conrad, Steven A; Barrett, Nicholas A; Saad, Mohamed; Cheema, Tariq; Pannu, Sonal; Romero, Ramiro Saavedra; Brochard, Laurent; Nava, Stefano; Ranieri, V Marco; May, Alexandra; Brodie, Daniel; Hill, Nicholas S.
Afiliação
  • Duggal A; Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Conrad SA; Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
  • Barrett NA; Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
  • Saad M; Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
  • Cheema T; Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
  • Pannu S; Division of Pulmonary Critical Care, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania.
  • Romero RS; Division of Pulmonary Critical Care and Sleep, Department of Medicine, Ohio State University, Columbus, Ohio.
  • Brochard L; Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota.
  • Nava S; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
  • Ranieri VM; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
  • May A; Respiratory and Critical Care Unit, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy.
  • Brodie D; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
  • Hill NS; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Am J Respir Crit Care Med ; 209(5): 529-542, 2024 03 01.
Article em En | MEDLINE | ID: mdl-38261630
ABSTRACT
Rationale It is unclear whether extracorporeal CO2 removal (ECCO2R) can reduce the rate of intubation or the total time on invasive mechanical ventilation (IMV) in adults experiencing an exacerbation of chronic obstructive pulmonary disease (COPD).

Objectives:

To determine whether ECCO2R increases the number of ventilator-free days within the first 5 days postrandomization (VFD-5) in exacerbation of COPD in patients who are either failing noninvasive ventilation (NIV) or who are failing to wean from IMV.

Methods:

This randomized clinical trial was conducted in 41 U.S. institutions (2018-2022) (ClinicalTrials.gov ID NCT03255057). Subjects were randomized to receive either standard care with venovenous ECCO2R (NIV stratum n = 26; IMV stratum n = 32) or standard care alone (NIV stratum n = 22; IMV stratum n = 33). Measurements and Main

Results:

The trial was stopped early because of slow enrollment and enrolled 113 subjects of the planned sample size of 180. There was no significant difference in the median VFD-5 between the arms controlled by strata (P = 0.36). In the NIV stratum, the median VFD-5 for both arms was 5 days (median shift = 0.0; 95% confidence interval [CI] 0.0-0.0). In the IMV stratum, the median VFD-5 in the standard care and ECCO2R arms were 0.25 and 2 days, respectively; median shift = 0.00 (95% confidence interval 0.00-1.25). In the NIV stratum, all-cause in-hospital mortality was significantly higher in the ECCO2R arm (22% vs. 0%, P = 0.02) with no difference in the IMV stratum (17% vs. 15%, P = 0.73).

Conclusions:

In subjects with exacerbation of COPD, the use of ECCO2R compared with standard care did not improve VFD-5. Clinical trial registered with www.clinicaltrials.gov (NCT03255057).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica / Ventilação não Invasiva Tipo de estudo: Clinical_trials Limite: Adult / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica / Ventilação não Invasiva Tipo de estudo: Clinical_trials Limite: Adult / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article