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ASSESSMENT OF THE EFFECTIVENESS OF EXTRACORPOREAL CARBON DIOXIDE REMOVAL IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME
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Abstract
Objective: To assess the effectiveness of extracorporeal carbon dioxide removal (ECCO₂R) in improving arterial blood gas parameters and respiratory mechanics in patients with acute respiratory distress syndrome (ARDS). Subjects: Patients indicated for ECCO₂R at the Center for Critical Care Medicine – Bach Mai Hospital from July 2024 to September 2025. Methods: A retrospective descriptive observational study with convenient sampling included all ARDS patients who underwent ECCO₂R during the study period; data were collected from medical records and case report forms and analyzed using SPSS. Results: In our study population of 15 patients with ARDS, males predominated (73.3%), while the mean age was comparable between sexes (58.5 ± 15.1 years in males vs. 58.0 ± 8.8 years in females). At baseline, patients exhibited severe respiratory acidosis and high ventilatory pressures, with a mean pH of 7.23 ± 0.10, median PaCO₂ of 60 mmHg (IQR 16.0), plateau pressure (Pplat) of 30 cmH₂O (IQR 4.0), driving pressure of 22 cmH₂O (IQR 5.0), and a median tidal volume of 7.0 ml/kg PBW. After 2 hours of ECCO₂R, these parameters improved markedly: pH increased to 7.36 ± 0.11, PaCO₂ decreased to 42 mmHg (IQR 15.0), accompanied by reductions in Pplat (25 cmH₂O), driving pressure (20 cmH₂O), and tidal volume (6.0 ml/kg PBW). These improvements were sustained at 6 hours, 24 hours, and day 2, with pH reaching 7.38 ± 0.09 and PaCO₂ stabilizing at 46 mmHg, while Pplat and driving pressure remained at 22 cmH₂O and 16.5 cmH₂O, respectively, and tidal volume consistently maintained within the lower protective range (5.0 ml/kg PBW). Conclusion: ECCO₂R improves blood gas parameters, reduces plateau pressure and driving pressure, and facilitates lung-protective ventilation in patients with ARDS.
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Keywords
ECCO₂R, ARDS, lung-protective ventilation, Driving pressure, Plateau pressure
References
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