PURPOSE 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.
PURPOSE 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 ARDSpatients. 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.
Authors: J D Kimmel; D T Arazawa; S-H Ye; V Shankarraman; W R Wagner; W J Federspiel Journal: J Mater Sci Mater Med Date: 2013-07-26 Impact factor: 3.896
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Authors: Simon Habran; Thomas Desaive; Philippe Morimont; Bernard Lambermont; Pierre Dauby Journal: Med Biol Eng Comput Date: 2017-08-09 Impact factor: 2.602
Authors: Peter D Wearden; William J Federspiel; Scott W Morley; Meir Rosenberg; Paul D Bieniek; Laura W Lund; Burt D Ochs Journal: Intensive Care Med Date: 2012-08-25 Impact factor: 17.440
Authors: Steffen Weber-Carstens; Anton Goldmann; Michael Quintel; Armin Kalenka; Stefan Kluge; Jürgen Peters; Christian Putensen; Thomas Müller; Simone Rosseau; Bernhard Zwißler; Onnen Moerer Journal: Dtsch Arztebl Int Date: 2013-08-19 Impact factor: 5.594