Extracorporeal CO2 Removal May Improve Renal Function of Patients with ARDS and Acute Kidney Injury

Attenuation of inflammatory and apoptotic response in patients with acute respiratory
distress syndrome (ARDS) have been associated to the reduction in end-organs failure and the
improvement in outcome observed with conventional protective ventilation . Recent data
show that further reduction of tidal volume (VT) improves outcome but extracorporeal CO2
removal (ECCO2R) is needed to manage respiratory acidosis .
Mechanical ventilation is an independent risk factor of mortality in patients with acute
kidney injury (AKI) . Increased plasma concentration of inflammatory mediators and
apoptosis of renal tubular cells are associated with AKI.
Recent studies propose to incorporate ECCO2R in conventional renal replacement
therapy (RRT) circuit to simultaneously support lung and kidney functions (5, 6). However,
data comparing RRT+ECCO2R (RRT+) with ultra-protective ventilation and RRT only with
conventional ventilation are not available. This study set up to examine the hypothesis that
adding RRT+ allows ultra-protective ventilation that preserves renal function through
attenuation of inflammation and apoptosis.