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Beitragstitel Prediction of mortality in patients treated with low flow veno-venous extracorporeal CO2 removal for acute hypercapnic respiratory failure
Autor:innen
  1. Matthias Hilty UniversitätsSpital Zürich Präsentierende:r
  2. Shalimar M Konopasek University Hospital of Zurich
  3. Marco Maggiorini UniversitätsSpital Zürich
Präsentationsform ePoster
Themengebiete
  • SGI Ärzteschaft | SSMI médecins
Abstract-Text Background
Hypercapnic respiratory failure in critical illness retains a high morbidity and mortality. Low flow extracorporeal CO2 removal (ECCO2R) has been shown to enable lung protective ventilation or spontaneous breathing, but patient selection remains challenging. Our hypothesis was that in patients suffering from hypercapnic respiratory failure, factors such as underlying disease, type and duration of respiratory support and predictive scores developed for ECMO therapy could improve patient selection for ECCO2R.
Methods
70 patients admitted to the medical ICU at the University Hospital of Zurich between 10/2009 and 02/2017 were treated with ECCO2R if pH≤7.25 and/or PaCO2≥9kPa while reaching the limits of lung protective ventilation (VT < 6ml/kg, Ppeak < 30, dP < 15mbar) or respiratory exhaustion during spontaneous breathing (n=48 and 22). Indication, treatment protocol, RESP and PRESERVE score were compared retrospectively with in-hospital mortality. Both RESP (-22–15 points) and PRESEVRE (0–14 points) scores include age, comorbidities, duration and parameters of mechanical ventilation. The former further includes specific diagnoses and CNS dysfunction, while the latter also includes SOFA score.
Results
A total of 9806 hours of ECCO2R treatment were analyzed. Underlying disease was ARDS (n=27), COPD (n=12), bronchiolitis obliterans (n=9), cystic fibrosis (n=10), pulmonary fibrosis (n=8) and other causes (n=4). PaCO2 decreased from 9.1±2.0 to 7.1±1.5kPa within the first 24h of treatment (p < 0.0001), while pH increased from 7.27±0.10 to 7.35±0.08 (p < 0.0001) and lung protective ventilation could be maintained. Overall, mortality was 47% and was highest in ARDS, bronchiolitis obliterans and pulmonary fibrosis (p < 0.01) and mechanically ventilated patients > 6 days before initiation of ECCO2R (p=0.01). PRESERVE score differentiated well between survivors and non-survivors (4.3±2.7 vs 7.0±2.7, p < 0.0001), while RESP score distinguished less clearly (-0.3±3.2 vs -1.9±3.5, p=0.03). Receiver operating characteristics analysis revealed an AUC of 0.80 and 0.66, suggesting a cut-off of 7 and 0.
Conclusions
In hypercapnic respiratory failure, careful selection of patients for ECCO2R therapy may help to avoid treatment futility. In mechanically ventilated patients, decision should take into account underlying disease and duration of respiratory support. PRESERVE score < 7 reliably identifies patients with a favorable outcome regarding in-hospital mortality.