Schmidt M, et al. - Whether extracorporeal carbon-dioxide removal (ECCO₂R) managed with a renal replacement therapy (RRT) platform allows very low tidal volume (VT) ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS) in a safe and feasible manner, was determined. Mean treatment duration was 31 ± 22 h and day-28 mortality was 15%. Following VT reduction, no changes were visible in the partial alveolar oxygen pressure (PaO₂)/fraction of inspired oxygen (FiO₂) ratio and respiratory-system compliance. Findings demonstrated feasibility as well as safety of a low-flow ECCO₂R device managed with an RRT platform to enable very low tidal volume ventilation with moderate increase in PaCO₂ in patients with mild-to-moderate ARDS.