1,721,042 research outputs found
Extracorporeal membrane oxygenation in adult patients with acute respiratory distress syndrome
No full textPurpose of review
To examine the role of extracorporeal membrane oxygenation (ECMO) as potential therapeutic option for
severe cases of acute respiratory distress syndrome (ARDS).
Recent findings
The use of ECMO to treat acute respiratory failure dramatically increased. Factors that may explain this
increase in the use of ECMO are H1N1 pandemic influenza, results of recent clinical trials and not lastly
the technological development and consequently the commercial pressure of the industry. Under these
circumstances, clinicians urgently need clinical trials and formal indication, contraindication and rules for
implementation to provide reproducible results.
Summary
Guidelines from the Extracorporeal Life Support Organization still indicate ECMO for acute severe
pulmonary failure potentially reversible and unresponsive to conventional management. The new definition
of ARDS (Berlin definition) addresses clinicians to the best treatment options in respect of the severity of
illness and allocates ECMO as a potential therapeutic option for patients with severe ARDS and a P/F ratio
lower than 100 and proposed that the indication of ECMO may be shifted from the treatment of choice for
refractory hypoxemia to the treatment of choice to minimize ventilator-induced lung injury
Role and potentials of low-flow CO2 removal system in mechanical ventilation
No full textPURPOSE OF REVIEW:
An analysis of the technological implementation of extracorporeal CO(2) removal (ECCO(2)R) techniques and of its clinical application. A new classification of ECCO(2)R, based on technological aspects, clinical properties and physiological performance, is proposed.
RECENT FINDINGS:
The use of a ventilation with lower tidal volumes has been proved successful in acute respiratory distress syndrome (ARDS) patients but can be extremely problematic, especially when dealing with respiratory acidosis. The implementation of ECCO(2)R devices can represent the missing link between the prevention of ventilator-induced lung injury and pH control. ECCO(2)R has attracted increasing interest because of new less-invasive approaches allowing an easier management of ARDS patients. Recent studies have also shown that ECCO(2)R can also be used in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and as a bridge to lung transplantation.
SUMMARY:
The future ventilatory management of patients with acute respiratory failure may include a minimally invasive extracorporeal carbon dioxide removal circuit associated with the least amount of ventilatory support (noninvasive in COPD and/or invasive in ARDS) to minimize sedation, prevent ventilator-induced acute lung injury and nosocomial infections. Randomized clinical trials in the pipeline will confirm this fascinating hypothesis
Novel approaches to minimize ventilator-induced lung injury
Full text linkPurpose of reviewTo discuss the mechanisms of ventilator-induced lung injury and the pro and cons of the different approaches proposed by literature to minimize its impact in patients with acute respiratory distress syndrome.Recent findingsMechanical ventilation is indispensable to manage respiratory failure. The evolution of knowledge of the physiological principles and of the clinical implementation of mechanical ventilation is characterized by the shift of interest from its capability to restore normal gas exchange' to its capability of causing further lung damage and multisystem organ failure.SummaryIf one of the essential teachings to young intensivists in the 1980s was to ensure mechanical ventilation restored being able to immediately drain a pneumothorax (barotrauma), nowadays priority we teach to young intensivists is to implement protective' ventilation to protect the lungs from the pulmonary and systemic effects of ventilator-induced lung injury (biotrauma). At the same time, priority of clinical research shifted from the search of optimal ventilator settings (best positive end-expiratory pressure) and to the evaluation of super-protective' ventilation that integrating partial or total extracorporeal support tries to minimize the use of mechanical ventilation
Extracorporeal CO2 removal and O2 transfer: A review of the concept, improvements and future development
No full textSince the 70s, the extracorporeal carbon dioxide removal concept played a role in adjusting respiratory acidosis associated with Tidal Volume reduction in protective ventilation settings.Kolobow and Gattinoni in 1977 were the first in introducing extracorporeal support, with the intent to separate carbon dioxide removal from oxygen uptake: carbon dioxide was removed by a pump-driven modified ECMO with veno-venous bypass, while oxygenation was accomplished by high levels of PEEP, applying only a few ventilator breaths at low volumes and low peak inspiratory pressures (" lung rest" ) to prevent damage of the compromised lungs.Nevertheless extracorporeal support was restricted to controlled clinical trials because of the high incidence of serious complications like hemorrhage, hemolysis and neurological impairments.Technological improvement led to the implementation of different devices less invasive for the patient and less complex for clinician (however unable to transfer oxygen): the interventional Lung Assist (iLA) and the Veno-venous ECCO2R, which brought back attention to the CO2 removal concept.Is foreseeable the future development of more efficient devices capable of removing a substantial amount of carbon dioxide allowing a more protective ventilation. This would embody the modern mechanical ventilation philosophy: avoid tracheal tubes, minimize sedation, prevent VILI and hospital acquired infections. © 2011 Elsevier Ltd
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