Reduction of ventilator settings allowed by intravenous oxygenator (IVOX) in ARDS patients.
OBJECTIVE
To evaluate the possibility of reducing ventilator settings to "safe" levels by extrapulmonary gas exchange with IVOX in ARDS patients.


METHODS
Uncontrolled open clinical study.


METHODS
Medical Intensive Care Unit of a University Hospital.


METHODS
6 patients with ARDS who entered into IVOX phase II clinical trials.


METHODS
The end-point of this study was to reduce ventilator settings from the initial values, recorded on the day of inclusion, to the following: peak inspiratory pressure < 40 cmH2O, mean airway pressure < 25 cmH2O and tidal volume < 10 ml/kg. Trials to achieve this goal were made on volume-controlled ventilation within the 24 h before and after IVOX insertion. Comparison of the results achieved during these trials used Wilcoxon test.


RESULTS
Before IVOX implantation reduction of ventilator settings was not possible in the 6 patients, despite a non-significant increase in PaO2/FIO2 was achieved. IVOX permitted significant decrease in PaCO2 (from 60.5 +/- 15 to 52 +/- 11 mmHg; p = 0.02) before any modification of the ventilatory mode. After IVOX insertion, a significant decrease of the ventilator settings was performed: peak and mean airway pressures dropped from 44 +/- 10 to 36.8 +/- 6.7; p = 0.02 and from 26.3 +/- 5.6 to 22.5 +/- 3.9 cmH2O; p = 0.02, respectively. Concommitantly, PaCO2 remained unchanged and PaO2/FIO2 increased significantly from 93 +/- 28 to 117 +/- 52; p = 0.04. The interruption of oxygen flow on IVOX was associated with a slight decrease of the oxygen variables. Tolerance of IVOX was satisfactory. However, a significant decrease both in cardiac index and in pulmonary wedge pressures (from 4.5 +/- 1.2 to 3.4 +/- 9; p = 0.03 and from 16 +/- 5 to 11 +/- 2; p = 0.04, respectively) was observed.


CONCLUSIONS
Gas exchange achieved by IVOX allowed reduction of ventilator settings in 6 ARDS patients in whom previous attempts have failed. CO2 removal by the device, may explain these results. Efficacy of IVOX on arterial oxygenation was uncertain.
Mira
J P
JP
Service de Réanimation Médicale, Hôpital Cochin, Paris, France.
Brunet
F
F
Belghith
M
M
Soubrane
O
O
Termignon
J L
JL
Renaud
B
B
Hamy
I
I
Monchi
M
M
Deslande
E
E
Fierobe
L
L
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002406:Catheterization, Peripheral; D005260:Female; D005268:Femoral Vein; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013990:Tidal Volume