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Respiratory Failure & Mechanical Ventilation

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Determinants of Effect of Extracorporeal CO2 Removal in Hypoxemic Respiratory Failure | NEJM Evidence


  • Ventilation strategy combining very low tidal volume (VT) with extracorporeal carbon dioxide removal (ECCO2R) is evaluated in patients with acute hypoxemic respiratory failure.

  • The effect of ECCO2R on mortality varies based on the ventilatory ratio (VR) and the severity of hypoxemia.

  • High VR (3 or higher) is associated with a higher probability of benefit and reduced mortality with the intervention.

  • Low VR (less than 3) is associated with a higher probability of increased mortality with the intervention.

  • The effect of the intervention also varies based on the severity of hypoxemia (PaO2:FiO2 ratio).

  • Benefit is more probable than harm in patients with PaO2:FiO2 110 mm Hg or higher but with low credibility.

  • The effect of the intervention does not vary substantially with respiratory system elastance (Ers).


Summary: This study reflects that fact that acute hypoxemic respiratory failure is a heterogeneous entity with significant differences in their baseline risk of death and treatment response. Ventilation strategy combining low VT with ECCO2R reduces mortality in patients with high ventilatory ratio and PaO2:FiO2 110 mm Hg or higher but does not have a significant effect on mortality in relation to respiratory system elastance.



Determinants of Effect of Extracorporeal CO2 Removal in Hypoxemic Respiratory Failure | NEJM Evidence

AHMED ABDULLAH
ekseibi
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