Extracorporeal carbon dioxide removal for patients with acute respiratory failure: a systematic review and meta-analysis

Abstract

Background Acute respiratory failure (ARF) is a common clinical critical syndrome with substantial mortality. Extracorporeal carbon dioxide removal (ECCO 2 R) has been proposed for the treatment of ARF. However, whether ECCO 2 R could provide a survival advantage for patients with ARF is still controversial. Methods Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to 30 April 2022. Randomized controlled trials (RCTs) and observational studies that examined the following outcomes were included: mortality, length of hospital and ICU stay, intubation and tracheotomy rate, mechanical ventilation days, ventilator-free days (VFDs), respiratory parameters, and reported adverse events. Results Four RCTs and five observational studies including 1173 participants with ARF due to COPD or ARDS were included in this meta-analysis. Pooled analyses of related studies showed no significant difference in overall mortality between ECCO 2 R and control group, neither in RCTs targeted ARDS or acute hypoxic respiratory failure patients (RR 1.05, 95% CI 0.83 to 1.32, p = 0.70, I 2 =0.0%), nor in studies targeted patients with ARF secondary to COPD (RR 0.80, 95% CI 0.58 to 1.11, p = 0.19, I 2 =0.0%). A shorter duration of ICU stay in the ECCO 2 R group was only obtained in observational studies (WMD −4.25, p < 0.01), and ECCO 2 R was associated with a longer length of hospital stay ( p = 0.02). ECCO 2 R was associated with lower intubation rate ( p < 0.01) and tracheotomy rate ( p = 0.01), and shorter mechanical ventilation days ( p < 0.01) in comparison to control group in ARF patients with COPD. In addition, an improvement in pH ( p = 0.01), PaO2 ( p = 0.01), respiratory rate ( p < 0.01), and PaCO2 ( p = 0.04) was also observed in patients with COPD exacerbations by ECCO 2 R therapy. However, the ECCO 2 R-related complication rate was high in six of the included studies. Conclusions Our findings from both RCTs and observational studies did not confirm a significant beneficial effect of ECCO 2 R therapy on mortality. A shorter length of ICU stay in the ECCO 2 R group was only obtained in observational studies, and ECCO 2 R was associated with a longer length of hospital stay. ECCO 2 R was a...

Association of red cell distribution width and its changes with the 30-day mortality in patients with acute respiratory failure: An analysis of MIMIC-IV database

“…Acute respiratory failure (ARF) is a common clinical critical syndrome along with damage to the function of multiple organs, such as the heart, kidney, and brain [1]. ARF is one of the common diseases in intensive care units (ICUs), and about 36% of patients with ARF die during hospitalization [2].…”