Retrospective analysis of the SUPERNOVA trial exploring the hypothesis that efficacy and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate reduction of tidal volume (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59 m2; blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/min) CO2 extraction capacity. Ninety-five patients with moderate ARDS were included (33 patients treated with lower and 62 patients treated with higher CO2 extraction devices). We found that (1) VT of 4 mL/kg was reached by 55% and 64% of patients with the lower extraction versus 90% and 92% of patients with higher extraction devices at 8 and 24 hours from baseline, respectively (p<0.001), and (2) percentage of patients experiencing episodes of ECCO2R-related haemolysis and bleeding was higher with lower than with higher extraction devices (21% vs 6%, p=0.045% and 27% vs 6%, p=0.010, respectively). Although V T of 4 mL/kg could have been obtained with all devices, this was achieved frequently and with a lower rate of adverse events by devices with higher CO2 extraction capacity.

中文翻译：

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允许超保护性通气的较低与较高 CO2 提取装置的有效性和安全性：SUPERNOVA 研究的二次分析

SUPERNOVA 试验的回顾性分析探索了以下假设：体外二氧化碳去除 (ECCO2R) 促进将急性呼吸窘迫综合征 (ARDS) 患者的潮气量 (VT) 降低至 4 mL/kg 的有效性和安全性可能因不同系统而异较低（膜长度面积 0.59 平方米；血流量 300–500 毫升/分钟）和较高（膜面积 1.30 平方米；血流量在 800 到 1000 毫升/分钟之间）CO2 提取能力。包括 95 名中度 ARDS 患者（33 名患者使用较低的 CO2 提取装置治疗，62 名患者使用较高的 CO2 提取装置治疗）。我们发现 (1) 在距基线 8 小时和 24 小时时，采用较低拔牙装置的患者分别有 55% 和 64% 的患者达到了 4 mL/kg 的 VT，而使用较高拔牙装置的患者分别达到 90% 和 92%（p< 0.001), (2) 经历 ECCO2R 相关溶血和出血发作的患者百分比高于使用较高提取装置的患者（分别为 21% 对 6%，p=0.045% 和 27% 对 6%，p=0.010）。尽管所有设备都可以达到 4 mL/kg 的 VT，但使用具有更高 CO2 提取能力的设备可以经常实现并且不良事件发生率较低。