The following is a summary of “Standard vs. carbone dioxide adapted kidney replacement therapy in hypercapnic ARDS patients: a randomized controlled pilot trial (BigBIC),” published in the June 2024 issue of Critical Care by Kunz et al.
Current continuous kidney replacement therapy (CKRT) approaches may not account for the body’s natural kidney response to manage hypercapnia.
Researchers conducted a prospective study assessing the feasibility, safety, and clinical efficacy of pCO2-adapted CKRT in patients with hypercapnic acute respiratory distress syndrome (ARDS).
They conducted the study at 5 ICUs in Charite—Universitätsmedizin Berlin, Germany. The study enrolled patients in mechanical ventilation (MV) with hypercapnic ARDS (pCO2, greater than 7.33 kPa) who were already receiving citrate-anticoagulated CKRT. Patients were randomly assigned in a 1:1 ratio to either a control group with a fixed bicarbonate target of 24 mmol/L or a pCO2-adapted group of CKRT where the bicarbonate target was adjusted to mimic the body’s natural response to elevated CO2 levels. The study duration was 6 days, and the primary outcome was measured by the bicarbonate level in the blood after 72 hours. Additionally, the safety and various clinical outcomes of all participants were monitored.
The result showed 40 patients (80% male) from September 2021 to May 2023. After randomization, five patients were excluded from the analysis (three in the control group and two in the intervention group). Among the remaining 35 patients, the median plasma bicarbonate level at 72 hours was significantly higher in the pCO2-adapted CKRT group (30.70 mmol/L,] [IQR] 29.48-31.93) than the control group (26.40 mmol/L, IQR 25.63-26.88; P<0.0001). Additionally, a more significant proportion of patients in the pCO2-adapted CKRT group received tidal volume less than 8 ml/kg predicted body weight. The 30-day mortality was 10 out of 16 patients (63%) in the control group, compared to 8 out of 19 patients (42%) in the intervention group (P=0.26)
Investigators concluded that adjusting CKRT to match the body’s natural way of balancing acid levels in the blood during severe ARDS appears practical and safe and holds promise for patient care improvement.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04979-z
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