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Intensive Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Right ventricular (RV) failure is a common complication in moderate-to-severe acute respiratory distress syndrome (ARDS). RV failure is exacerbated by hypercapnic acidosis and overdistension induced by mechanical ventilation. Veno-venous extracorporeal CO\n                      <jats:sub>2<\/jats:sub>\n                      removal (ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R) might allow ultraprotective ventilation with lower tidal volume (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>T<\/jats:italic>\n                      <\/jats:sub>\n                      ) and plateau pressure (\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>plat<\/jats:sub>\n                      ). This study investigated whether ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R therapy could affect RV function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a quasi-experimental prospective observational pilot study performed in a French medical ICU. Patients with moderate-to-severe ARDS with PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      ratio between 80 and 150\u00a0mmHg were enrolled. An ultraprotective ventilation strategy was used with\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>T<\/jats:italic>\n                      <\/jats:sub>\n                      at 4\u00a0mL\/kg of predicted body weight during the 24\u00a0h following the start of a low-flow ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R device. RV function was assessed by transthoracic echocardiography (TTE) during the study protocol.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The efficacy of ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R facilitated an ultraprotective strategy in all 18 patients included. We observed a significant improvement in RV systolic function parameters. Tricuspid annular plane systolic excursion (TAPSE) increased significantly under ultraprotective ventilation compared to baseline (from 22.8 to 25.4\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Systolic excursion velocity (\n                      <jats:italic>S\u2019<\/jats:italic>\n                      wave) also increased after the 1-day protocol (from 13.8\u00a0m\/s to 15.1\u00a0m\/s;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). A significant improvement in the aortic velocity time integral (VTIAo) under ultraprotective ventilation settings was observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). There were no significant differences in the values of systolic pulmonary arterial pressure (sPAP) and RV preload.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Low-flow ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R facilitates an ultraprotective ventilation strategy thatwould improve RV function in moderate-to-severe ARDS patients. Improvement in RV contractility appears to be mainly due to a decrease in intrathoracic pressure allowed by ultraprotective ventilation, rather than a reduction of PaCO\n                      <jats:sub>2<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13613-020-00784-3","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T08:04:57Z","timestamp":1610006697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Ultraprotective ventilation allowed by extracorporeal CO2 removal improves the right ventricular function in acute respiratory distress syndrome patients: a quasi-experimental pilot study"],"prefix":"10.1016","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4497-5403","authenticated-orcid":false,"given":"Suzanne","family":"Goursaud","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Valette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Dupeyrat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Daubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"du Cheyron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"key":"784_CR1","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1056\/NEJM200005043421801","volume":"342","author":"ARDS Network","year":"2000","unstructured":"ARDSNetwork. 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Informed consent was obtained from patients or legally authorized surrogates.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"3"}}