Extracorporeal CO2 removal may improve renal function of patients with acute respiratory distress syndrome and acute kidney injury. an open-label, interventional clinical trial

Attenuation of inflammatory and apoptotic responses in patients with acute respiratory distress syndrome (ARDS) has been associated with a reduction in end-organ failure and the improvement in outcome observed with conventional protective ventilation (1). Recent data show that further reductions of Vt improve outcomes, but extracorporeal CO2 removal (ECCO2R) is needed to manage respiratory acidosis (2). Mechanical ventilation is an independent risk factor for mortality in patients with acute kidney injury (AKI) (3). Increased plasma concentrations of inflammatory mediators and apoptosis of renal tubular cells are associated with AKI (4). Recent studies have proposed the incorporation of ECCO2R into the conventional renal replacement therapy (RRT) circuit to support lung and kidney functions simultaneously (5, 6). However, data comparing RRT+ECCO2R (RRT+) plus ultraprotective ventilation with RRT alone plus conventional ventilation are not available. In this study, we sought to examine the hypothesis that adding RRT+ allows ultraprotective ventilation that preserves renal function through attenuation of inflammation and apoptosis.