PROTECTIVE VENTILATION WITH CO2-REMOVAL TECHNIQUE IN PATIENTS WITH ARDS

INTRODUCTION. 30% of ARDS patients ventilated according to NIH protocol presents morphological
(CT scan) and functional (Stress Index>1) conditions of hyperinflation even with
Plateau pressure (Pplat) < 30 cmH2O. Values of Pplat lower than 26 cmH2O are associated
with a condition of more protective ventilation [1]. In patients at risk of hyperinflation, use of
alternative techniques such as CO2-removal may allow the reduction of Tidal Volume (Vt) and
Pplat. Aim of the study was to verify the efficacy of CO2-removal technique in reducing Vt and
consequently Pplat to obtain a Stress Index value equal to 1.
METHODS. In 5 ARDS patients presenting a Pplat >26 cmH2O Vt was lowered with CO2-
removal device support (flow ml/min = 345 ± 67) to maintain a pH >7,30. Ventilatory parameters
and SI value were recorded at baseline,at the onset CO2 removal, 24,48 and 72 hours.
CONCLUSION. Further reduction in Vt after application of CO2 removal device led to significant
decrease in Pplat reaching the Stress Index target value equal to 1; CO2-removal techinque could be
useful to achieve more protective ventilation in ARDS patients.
REFERENCE(S). [1] Terragni PP et al “Tidal Hyperinflation during Low Tidal Volume Ventilation
in Acute Respiratory Distress Syndrome”. Am J Respir Crit Care Med 2007 Jan 15; 175
(2): 160-6