2022/10/05 by Andrew Boyle, Andrew J Boyle, Clíona McDowell +11 · 7 citations
Engineering · Medicine · #Acute respiratory failure #Anesthesia #Carbon dioxide #Cardiology #Extracorporeal #Intensive care medicine #Internal medicine #Mechanical Circulatory Support Devices #Mechanical ventilation #Medicine #Nosocomial Infections in ICU #Randomized controlled trial #Respiratory Support and Mechanisms #Respiratory failure #Respiratory minute volume #Respiratory system #Rest (music) #Surgery #Term (time) #Tidal volume #Ventilation (architecture) #Volume (thermodynamics)
paper · pdf · doi:10.1136/thorax-2022-218874
published in Thorax 78(8), 767-774 (BMJ)
openalex publication_date 2022/10/05 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
Introduction Lower tidal volume ventilation, facilitated by veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R), does not improve 90-day mortality in patients with acute hypoxaemic respiratory failure (AHRF). The aim of this analysis was to evaluate the effect of this therapeutic strategy on long-term outcomes. Methods This was a prespecified analysis of the REST trial, a UK-wide multicentre randomised clinical trial that compared lower tidal volume ventilation, facilitated by vv-ECCO 2 R (intervention), with standard care in the treatment of patients with moderate-to-severe AHRF. Mortality to 2 years was assessed, while respiratory function, post-traumatic stress disorder, cognitive function and health-related quality of life were evaluated in survivors at 1 year using standardised questionnaires. Results Of 412 patients enrolled into the REST trial, 391 (95%) had 2-year mortality outcome data available. There was no difference in the time to death between intervention and standard care (HR 1.08 (0.81, 1.44); log-rank test p=0.61). 161 patients alive at 1 year provided at least one questionnaire response. There was no difference in respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life between patients allocated to intervention or standard care. Conclusion Lower-tidal volume ventilation facilitated by vv-ECCO 2 R does not affect 1-year mortality in patients with moderate-to-severe AHRF. Of the patients who provided questionnaire responses, there was no treatment effect on long-term respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life. Trial registration number ClinicalTrials.gov identifier: NCT02654327 .