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Master Thesis

La ventilation ultra-protectrice sous décarboxylation extracorporelle chez des patients en SDRA modéré à sévère à compliance pulmonaire effondrée

Abstract : The purpose of this single-centered study was to describe retrospectively the use of ultra-protective mechanical ventilation in selected patients with ARDS. Transpulmonary pressure measures were used to determine the necessary PEEP level and evaluate the risk of ventilator induced lung injury (VILI). In the event of high pulmonary stress with a protective-ventilation and “best PEEP” strategy, ultra-protective ventilation was initiated to reach an elastance-derived end- inspiratory transpulmonary pressure under 20 cmH2O due to reduced VT. Increase of partial pressure of carbon dioxide (PaCO2) induced or aggravated by the decrease of minute volume ventilation were treated with veno-venous extracorporeal CO2 removal (ECCO2R). During COVID crisis, between 2019 and 2021, 3 patients among 62 admitted in our intensive care unit were eligible for this protocol. The main outcome to reduce VILI with an effective control of PaCO2 was achieved. No complications following this process were observed and the patients were all able to regain their homes. Despite the small sample size, this strategy seems to be safe and feasible. Complementary trials are required to evaluate its relevance in selected ARDS.
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https://dumas.ccsd.cnrs.fr/dumas-03363569
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Submitted on : Monday, October 4, 2021 - 9:37:58 AM
Last modification on : Tuesday, October 26, 2021 - 3:21:51 AM

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  • HAL Id : dumas-03363569, version 1

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Gwendoline Esméralda Tania Rager. La ventilation ultra-protectrice sous décarboxylation extracorporelle chez des patients en SDRA modéré à sévère à compliance pulmonaire effondrée. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03363569⟩

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