Trial reportCritical care explorations2025
Evaluation of Plasma Biomarkers to Understand the Biology and Heterogeneity of Treatment Effect in Lower Tidal Volume Ventilation Facilitated by Extracorporeal CO2 Removal in Acute Hypoxemic Respiratory Failure: A Secondary Analysis of the REST Trial.
Trial report in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02654327 (pRotective vEntilation With Veno-venouS Lung assisT in Respiratory Failure), which is not on this map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
pRotective vEntilation With Veno-venouS Lung assisT in Respiratory Failure
Who cites it
2 citing papers in PubMed.
- Extracorporeal Carbon Dioxide Removal in Acute Respiratory Distress Syndrome: Physiologic Rationale and Phenotype-Based Perspectives.Medicina (Kaunas, Lithuania) · 2026Review
- ARDS Subphenotypes as a Guide to Therapy and Enrollment into Therapeutic Trials: Not So Fast.Journal of clinical medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
objectivesIn patients with acute hypoxemic respiratory failure (AHRF), the use of lower tidal volume ventilation facilitated by veno-venous extracorporeal CO2 removal (vv-ECCO2R) does not improve clinical outcomes. The primary objective of this analysis was to evaluate for differences in indices of systemic inflammation and ventilator-induced lung injury between patients treated with lower tidal volume ventilation facilitated by vv-ECCO2R and standard care. Secondary objectives included an evaluation for heterogeneity of treatment effect.
designSubstudy of a randomized clinical trial.
settingNine U.K. ICUs. PATIENTS: Moderate-to-severe AHRF (Pao2: Fio2 < 150mmHg [20ka]).
interventionPlasma samples obtained at baseline and day 3. MEASUREMENTS AND MAIN
resultsThe primary outcome was day 3 C-reactive protein (CRP). Clinical outcomes included 90-day mortality and ventilator-free days (VFD) until day 28. Exploratory analyses included an evaluation of plasma indices of lung injury, inflammation, and heterogeneity of treatment effect (HTE). Seventy-nine patients were enrolled, and 69 patients had paired plasma samples taken at baseline and day 3. There was no difference in day 3 plasma CRP (intervention 138.6 [70.4, 189.4] vs. standard care 113.0 [62.7, 233.8] mg/L; p = 0.72). Between baseline and day 3, there was a greater increase in plasma interleukin-18 in patients that received intervention compared with those that received standard care (Δ 337.7 [-128.9, 738.9] vs. 6.4 [-457.2, 6.4] pg/mL p = 0.05). In patients with high interleukin-18, allocation to intervention was associated with increased VFDs (p = 0.03). Similarly in patients with a hyperinflammatory phenotype, the intervention was independently associated with increased VFDs (p < 0.01) and decreased 90-day mortality (p = 0.01).
conclusionsIn patients with moderate-to-severe AHRF, lower tidal volume ventilation, facilitated by vv-ECCO2R, was not associated with a difference in day 3 plasma CRP, but was associated with an increase in plasma interleukin-18 between baseline and day 3. Baseline plasma interleukin-18 and inflammatory phenotypes may identify subgroups of patients with moderate-to-severe AHRF that benefit from lower tidal volume ventilation facilitated by vv-ECCO2R.
trial registrationNCT02654327.
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