Respiratory failure & ventilation
A prospective clinical evaluation of new ECCO2R technology in mild to moderate acute respiratory distress syndrome (ARDS) patients: assessing ultra-lung-protective ventilation with PRISMALUNG+
Authors' conclusion
This study demonstrates that hypercapnic acidosis occurring during ultra-low VT ventilation (ULPV) can be safely mitigated with ECCO₂R in mechanically ventilated patients with mild to moderate ARDS.
Study context
- Population
- Mechanically ventilated patients with mild to moderate ARDS, France16 with CRRT
- Participants
- 58 participants
- Exposure
- Before vs after 24 h of ECCO2R with ultra-lung-protective ventilation (ULPV)
- ECCO2Rn = 58
- Outcome
- Ventilation parameters, baseline vs 24 h
- Follow-up
- 24 h
Methodological detailsstandardised ULPV protocol, April 2021 to December 2023
- Standardised ULPV protocol
- April 2021 to December 2023
Main finding
As reported in the abstract
- VT decreased from 6.0 [6.0-6.1] to 4.0 [4.0-4.30] (p < 0.0001)
- ∆P decreased from 12.0 [10.0-16.0] cmH2O to 10.0 [8.0-13.0] cmH2O (p < 0.0001)
- Ventilatory ratio (VR) decreased from 1.7 [1.5-2.1] to 1.3 [1.0-1.6] (p < 0.0001)
- Mechanical power decreased from 18.8 [15.0-22.0] J/min to 11.8 [8.8-15.5] J/min (p < 0.0001)
- PaO2/FiO2 did not significantly change over time
- Respiratory acidosis resolved: normalisation of pH and reduction in PaCO2
Observational data: associations, not effects.
Further findings
Peak hypercapnia and respiratory acidosis during VT reduction, before ECCO2R initiation
- PaCO2 53.0 [50.0-55.0] mmHg
- pH 7.30 [7.24-7.36]
Safety
Major bleeding events, intracranial hemorrhages, hemolysis · until discharge or day 28
- No major bleeding events, intracranial hemorrhages, or hemolysis reported
Original publication
A prospective clinical evaluation of new ECCO2R technology in mild to moderate ARDS patients: assessing ultra-lung-protective ventilation with PRISMALUNG+. Crit Care. Published 6 January 2026. doi:10.
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