Many patients admitted to the Intensive Care Unit (ICU) need a breathing machine, or ventilator, to help them breathe and ensure that enough oxygen gets into their blood and carbon dioxide is removed. For reasons that are unclear, when people are critically ill, their lungs often fail; this is termed “acute respiratory failure”. Currently, there are no specific treatments other than placing the person on a ventilator to help bellow air in and out of the lungs. In light of this we are investigating a treatment for acute respiratory (lung) failure. Studies have suggested that although ventilation is a life-saving intervention, it may damage the lungs and prevent healing and repair. This is especially so when ventilation requires excessive pressure and volume to ensure enough oxygen is provided and carbon dioxide is removed. There is currently a device called extracorporeal carbon dioxide removal (ECCOR), which is similar to kidney dialysis, that can remove carbon dioxide from the blood. This device is used in the UK sometimes and has the potential to assist ventilation and allow ventilation pressure and volume to be reduced. We will determine if there is a greater chance of patient’s survival by applying ECCOR and using more protective ventilation. We will also look at whether ECCOR reduces the time patients spend on a ventilator and in hospital and also the quality of life and condition of the lungs when the patient is discharged. We think that treating patients early in this situation with protective ventilation helps them to recover so we need to include patients to the study within 48 hours of becoming unwell in ICU. To assess the role of ECCO2R we are recruiting 1,120 patients from ICUs.
Protective ventilation with veno-venous lung assist in respiratory failure
The primary objective of this trial is to determine whether VVECCO2R and lower tidal volume mechanical ventilation in patients with acute hypoxaemic respiratory failure decreases mortality 90 days after randomisation.
Prof Danny McAuley
Dr Bill Tunnicliffe