The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function

Peter J McGuigan; Emma M Bowcock; Nicholas A Barrett; Bronagh Blackwood; Andrew J Boyle; Andrew J Cadamy; Luigi Camporota; John Conlon; Matthew E Cove; Michael A Gillies; Clíona McDowell; James J McNamee; Cecilia M O'Kane; Alex Puxty; Malcolm Sim; Rebecca Parsons-Simmonds; Tamas Szakmany; Neil Young; Sam Orde; Daniel F McAuley

doi:10.1097/CCE.0000000000001028

The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function

Peter J McGuigan, Emma M Bowcock, Nicholas A Barrett, Bronagh Blackwood, Andrew J Boyle, Andrew J Cadamy, Luigi Camporota, John Conlon, Matthew E Cove, Michael A Gillies, Clíona McDowell, James J McNamee, Cecilia M O'Kane, Alex Puxty, Malcolm Sim, Rebecca Parsons-Simmonds, Tamas Szakmany, Neil Young, Sam Orde, Daniel F McAuley

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Abstract

OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO 2R) has been investigated as a potential therapy for acute hypoxemic respiratory failure (AHRF) in the pRotective vEntilation with veno-venouS lung assisT in respiratory failure (REST) trial. We investigated the effect of this strategy on cardiac function, and in particular the right ventricle.

DESIGN: Substudy of the REST trial.

SETTING: Nine U.K. ICUs.

PATIENTS: Patients with AHRF (Pao 2/Fio 2 < 150 mm Hg [20 kPa]).

INTERVENTION: Transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were collected at baseline and postrandomization in patients randomized to ECCO 2R or usual care.

MEASUREMENTS: The primary outcome measures were a difference in tricuspid annular plane systolic excursion (TAPSE) on postrandomization echocardiogram and difference in NT-proBNP postrandomization.

RESULTS: There were 21 patients included in the echocardiography cohort (ECCO 2R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO 2R group compared with the usual care group postrandomization; 3.6 (3.1-4.2) mL/kg PBW versus 5.2 (4.9-5.7) mL/kg PBW, respectively ( p = 0.01). There was no difference in the primary outcome measure of mean (sd) TAPSE in the ECCO 2R and usual care groups postrandomization; 21.3 (5.4) mm versus 20.1 (3.2) mm, respectively ( p = 0.60). There were 75 patients included in the NT-proBNP cohort (ECCO 2R, n = 36; usual care, n = 39). Patient characteristics were similar in both groups at baseline. Median (interquartile range [IQR]) tidal volumes were lower in the ECCO 2R group than the usual care group postrandomization; 3.8 (3.3-4.2) mL/kg PBW versus 6.7 (5.8-8.1) mL/kg PBW, respectively ( p < 0.0001). There was no difference in median (IQR) NT-proBNP postrandomization; 1121 (241-5370) pg/mL versus 1393 (723-4332) pg/mL in the ECCO 2R and usual care groups, respectively ( p = 0.30).

CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO 2R, did not modify cardiac function.

Original language	English
Article number	e1028
Number of pages	13
Journal	Critical Care Explorations
Volume	6
Issue number	1
DOIs	https://doi.org/10.1097/CCE.0000000000001028
Publication status	Published - 01 Jan 2024

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The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function
Copyright 2024 the authors. This is an open access article published under a Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits distribution and reproduction for non-commercial purposes, provided the author and source are cited.
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McGuigan, P. J., Bowcock, E. M., Barrett, N. A., Blackwood, B., Boyle, A. J., Cadamy, A. J., Camporota, L., Conlon, J., Cove, M. E., Gillies, M. A., McDowell, C., McNamee, J. J., O'Kane, C. M., Puxty, A., Sim, M., Parsons-Simmonds, R., Szakmany, T., Young, N., Orde, S., & McAuley, D. F. (2024). The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function. Critical Care Explorations, 6(1), Article e1028. https://doi.org/10.1097/CCE.0000000000001028

@article{56c2c9ecca574fc998032fe694ede6af,

title = "The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function",

abstract = "OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO 2R) has been investigated as a potential therapy for acute hypoxemic respiratory failure (AHRF) in the pRotective vEntilation with veno-venouS lung assisT in respiratory failure (REST) trial. We investigated the effect of this strategy on cardiac function, and in particular the right ventricle. DESIGN: Substudy of the REST trial.SETTING: Nine U.K. ICUs.PATIENTS: Patients with AHRF (Pao 2/Fio 2 < 150 mm Hg [20 kPa]). INTERVENTION: Transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were collected at baseline and postrandomization in patients randomized to ECCO 2R or usual care. MEASUREMENTS: The primary outcome measures were a difference in tricuspid annular plane systolic excursion (TAPSE) on postrandomization echocardiogram and difference in NT-proBNP postrandomization.RESULTS: There were 21 patients included in the echocardiography cohort (ECCO 2R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO 2R group compared with the usual care group postrandomization; 3.6 (3.1-4.2) mL/kg PBW versus 5.2 (4.9-5.7) mL/kg PBW, respectively ( p = 0.01). There was no difference in the primary outcome measure of mean (sd) TAPSE in the ECCO 2R and usual care groups postrandomization; 21.3 (5.4) mm versus 20.1 (3.2) mm, respectively ( p = 0.60). There were 75 patients included in the NT-proBNP cohort (ECCO 2R, n = 36; usual care, n = 39). Patient characteristics were similar in both groups at baseline. Median (interquartile range [IQR]) tidal volumes were lower in the ECCO 2R group than the usual care group postrandomization; 3.8 (3.3-4.2) mL/kg PBW versus 6.7 (5.8-8.1) mL/kg PBW, respectively ( p < 0.0001). There was no difference in median (IQR) NT-proBNP postrandomization; 1121 (241-5370) pg/mL versus 1393 (723-4332) pg/mL in the ECCO 2R and usual care groups, respectively ( p = 0.30). CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO 2R, did not modify cardiac function. ",

author = "McGuigan, {Peter J} and Bowcock, {Emma M} and Barrett, {Nicholas A} and Bronagh Blackwood and Boyle, {Andrew J} and Cadamy, {Andrew J} and Luigi Camporota and John Conlon and Cove, {Matthew E} and Gillies, {Michael A} and Cl{\'i}ona McDowell and McNamee, {James J} and O'Kane, {Cecilia M} and Alex Puxty and Malcolm Sim and Rebecca Parsons-Simmonds and Tamas Szakmany and Neil Young and Sam Orde and McAuley, {Daniel F}",

note = "Copyright {\textcopyright} 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.",

year = "2024",

month = jan,

day = "1",

doi = "10.1097/CCE.0000000000001028",

language = "English",

volume = "6",

journal = "Critical Care Explorations",

issn = "2639-8028",

publisher = "Lippincott Williams and Wilkins",

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McGuigan, PJ, Bowcock, EM, Barrett, NA, Blackwood, B , Boyle, AJ, Cadamy, AJ, Camporota, L, Conlon, J, Cove, ME, Gillies, MA, McDowell, C, McNamee, JJ, O'Kane, CM, Puxty, A, Sim, M, Parsons-Simmonds, R, Szakmany, T, Young, N, Orde, S & McAuley, DF 2024, 'The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function', Critical Care Explorations, vol. 6, no. 1, e1028. https://doi.org/10.1097/CCE.0000000000001028

The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function. / McGuigan, Peter J; Bowcock, Emma M; Barrett, Nicholas A et al.
In: Critical Care Explorations, Vol. 6, No. 1, e1028, 01.01.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function

AU - McGuigan, Peter J

AU - Bowcock, Emma M

AU - Barrett, Nicholas A

AU - Blackwood, Bronagh

AU - Boyle, Andrew J

AU - Cadamy, Andrew J

AU - Camporota, Luigi

AU - Conlon, John

AU - Cove, Matthew E

AU - Gillies, Michael A

AU - McDowell, Clíona

AU - McNamee, James J

AU - O'Kane, Cecilia M

AU - Puxty, Alex

AU - Sim, Malcolm

AU - Parsons-Simmonds, Rebecca

AU - Szakmany, Tamas

AU - Young, Neil

AU - Orde, Sam

AU - McAuley, Daniel F

PY - 2024/1/1

Y1 - 2024/1/1

N2 - OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO 2R) has been investigated as a potential therapy for acute hypoxemic respiratory failure (AHRF) in the pRotective vEntilation with veno-venouS lung assisT in respiratory failure (REST) trial. We investigated the effect of this strategy on cardiac function, and in particular the right ventricle. DESIGN: Substudy of the REST trial.SETTING: Nine U.K. ICUs.PATIENTS: Patients with AHRF (Pao 2/Fio 2 < 150 mm Hg [20 kPa]). INTERVENTION: Transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were collected at baseline and postrandomization in patients randomized to ECCO 2R or usual care. MEASUREMENTS: The primary outcome measures were a difference in tricuspid annular plane systolic excursion (TAPSE) on postrandomization echocardiogram and difference in NT-proBNP postrandomization.RESULTS: There were 21 patients included in the echocardiography cohort (ECCO 2R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO 2R group compared with the usual care group postrandomization; 3.6 (3.1-4.2) mL/kg PBW versus 5.2 (4.9-5.7) mL/kg PBW, respectively ( p = 0.01). There was no difference in the primary outcome measure of mean (sd) TAPSE in the ECCO 2R and usual care groups postrandomization; 21.3 (5.4) mm versus 20.1 (3.2) mm, respectively ( p = 0.60). There were 75 patients included in the NT-proBNP cohort (ECCO 2R, n = 36; usual care, n = 39). Patient characteristics were similar in both groups at baseline. Median (interquartile range [IQR]) tidal volumes were lower in the ECCO 2R group than the usual care group postrandomization; 3.8 (3.3-4.2) mL/kg PBW versus 6.7 (5.8-8.1) mL/kg PBW, respectively ( p < 0.0001). There was no difference in median (IQR) NT-proBNP postrandomization; 1121 (241-5370) pg/mL versus 1393 (723-4332) pg/mL in the ECCO 2R and usual care groups, respectively ( p = 0.30). CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO 2R, did not modify cardiac function.

AB - OBJECTIVES: Lower tidal volume ventilation (targeting 3 mL/kg predicted body weight, PBW) facilitated by extracorporeal carbon dioxide removal (ECCO 2R) has been investigated as a potential therapy for acute hypoxemic respiratory failure (AHRF) in the pRotective vEntilation with veno-venouS lung assisT in respiratory failure (REST) trial. We investigated the effect of this strategy on cardiac function, and in particular the right ventricle. DESIGN: Substudy of the REST trial.SETTING: Nine U.K. ICUs.PATIENTS: Patients with AHRF (Pao 2/Fio 2 < 150 mm Hg [20 kPa]). INTERVENTION: Transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were collected at baseline and postrandomization in patients randomized to ECCO 2R or usual care. MEASUREMENTS: The primary outcome measures were a difference in tricuspid annular plane systolic excursion (TAPSE) on postrandomization echocardiogram and difference in NT-proBNP postrandomization.RESULTS: There were 21 patients included in the echocardiography cohort (ECCO 2R, n = 13; usual care, n = 8). Patient characteristics were similar in both groups at baseline. Median (interquartile range) tidal volumes were lower in the ECCO 2R group compared with the usual care group postrandomization; 3.6 (3.1-4.2) mL/kg PBW versus 5.2 (4.9-5.7) mL/kg PBW, respectively ( p = 0.01). There was no difference in the primary outcome measure of mean (sd) TAPSE in the ECCO 2R and usual care groups postrandomization; 21.3 (5.4) mm versus 20.1 (3.2) mm, respectively ( p = 0.60). There were 75 patients included in the NT-proBNP cohort (ECCO 2R, n = 36; usual care, n = 39). Patient characteristics were similar in both groups at baseline. Median (interquartile range [IQR]) tidal volumes were lower in the ECCO 2R group than the usual care group postrandomization; 3.8 (3.3-4.2) mL/kg PBW versus 6.7 (5.8-8.1) mL/kg PBW, respectively ( p < 0.0001). There was no difference in median (IQR) NT-proBNP postrandomization; 1121 (241-5370) pg/mL versus 1393 (723-4332) pg/mL in the ECCO 2R and usual care groups, respectively ( p = 0.30). CONCLUSIONS: In patients with AHRF, a reduction in tidal volume facilitated by ECCO 2R, did not modify cardiac function.

U2 - 10.1097/CCE.0000000000001028

DO - 10.1097/CCE.0000000000001028

M3 - Article

C2 - 38213419

SN - 2639-8028

VL - 6

JO - Critical Care Explorations

JF - Critical Care Explorations

IS - 1

M1 - e1028

ER -

The effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal compared with conventional lung protective ventilation on cardiac function

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