Supplementary Material for: Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO₂R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO₂ with very low extracorporeal blood flows (&lt;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO₂R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO₂R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO₂ clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO₂R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

<b><i>背景：</i></b> 重症急性呼吸衰竭患者在局部与全身介质介导的多器官功能衰竭状态下，常伴随肺与肾联合损伤。针对该临床难题，体外二氧化碳清除（extracorporeal carbon dioxide removal, ECCO₂R）系统已被整合至连续性肾脏替代治疗（continuous renal replacement therapy, CRRT）平台，以实现联合器官支持，可在极低体外血流量（<400 mL/min）下实现高效的二氧化碳清除。<b><i>目标：</i></b> 评估在二级重症监护病房中，采用PrismaLung®-Prismaflex®开展ECCO₂R-CRRT联合器官支持，对合并急性肾损伤（acute kidney injury, AKI）的高碳酸性呼吸性酸中毒患者的疗效与安全性。<b><i>方法：</i></b> 本研究为回顾性观察性研究，纳入因轻中度急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）或慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease, aeCOPD）而接受PrismaLung®-Prismaflex®治疗的患者。主要研究终点包括：机械通气患者转为保护性通气并成功拔管，以及接受无创通气（noninvasive ventilation, NIV）的患者转为有创机械通气。研究记录了临床实验室相关数据以及ECCO₂R-CRRT的操作特征参数。<b><i>结果：</i></b> 整体而言，17例机械通气患者中有12例成功转为保护性通气；在整个观察周期内，二氧化碳清除效果维持良好，pH值快速得到纠正。本治疗方案使5例接受无创通气的患者中有4例避免了无创通气失败。未记录到与治疗相关的并发症。<b><i>结论：</i></b> 对于合并急性肾损伤的慢性阻塞性肺疾病急性加重及急性呼吸窘迫综合征患者，ECCO₂R-CRRT治疗兼具有效性与安全性。