Pulmonary And Renal Support During Acute Respiratory Distress Syndrome
Pulmonary And Renal Support During Acute Respiratory Distress Syndrome
In patients presenting with the acute respiratory distress syndrome (ARDS), mechanical
 ventilation with low tidal volume (6 ml/kg predicted body weight) is the current gold
 standard for supportive care. However, despite a relative low tidal volume, approximatively
 one third of patients will experienced tidal hyperinflation, a phenomenon known to induce
 pulmonary and systemic inflammatory response. A further reduction of the tidal volume to 4
 ml/kg (PBW) will prevent pulmonary area from tidal hyperinflation. As a result, hypercarbia
 and respiratory acidosis are commonly observed with such very low tidal ventilation. Extra
 corporeal CO2 removal is one of a mean to normalize arterial CO2 tension.

 Patients with ARDS also frequently develop acute renal failure which may required Renal
 Replacement Therapy. Some data suggests that starting early the RRT may favor outcome.

 The investigators hypothesized that a strategy combining ECCOR and RRT early in the course of
 patients presenting ARDS and acute renal failure will allow the tidal volume to be further
 reduced, providing lung protection, while avoiding the arterial CO2 tension to be increased.

 For this purpose, the investigators sought to evaluate the safety and efficacy of adding a
 membranel oxygenator within an hemofiltration circuit, either upstream or downstream of the
 hemofilter.
Inclusion Criteria:

 -  Acute Respiratory Distress Syndrome according to the AECC definition

 -  Acute Renal Failure according to the RIFLE definition

 Exclusion Criteria:

 -  Age < 18 years

 -  PaO2/FiO2 < 100 with FIO2 = 1 and PEEP > 18 cmH2O

 -  DNR order or death expected within the next 3 days

 -  Intracranial haemorrhage or hypertension

 -  Heparin allergy