Document Detail


Extracorporeal CO2 removal.
MedLine Citation:
PMID:  20427969     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The extracorporeal carbon dioxide removal (ECCO(2)R) concept, used as an integrated tool with conventional ventilation, plays a role in adjusting respiratory acidosis consequent to tidal volume (Vt) reduction in a protective ventilation setting. This concept arises from the extracorporeal membrane oxygenation (ECMO) experience. Kolobow and Gattinoni were the first to introduce extracorporeal support, with the intent to separate carbon dioxide removal from oxygen uptake; they hypothesized that to allow the lung to 'rest' oxygenation via mechanical ventilation could be dissociated from decarboxylation via extracorporeal carbon dioxide removal. Carbon dioxide is removed by a pump-driven modified ECMO machine with veno-venous bypass, while oxygenation is accomplished by high levels of positive end-expiratory pressure, with a respiratory rate of 3-5 breaths/min. The focus was that, in case of acute respiratory failure, CO(2) extraction facilitates a reduction in ventilatory support and oxygenation is maintained by simple diffusion across the patient's alveoli, called 'apneic oxygenation'. Concerns have been raised regarding the standard use of extracorporeal support because of the high incidence of serious complications: hemorrhage; hemolysis, and neurological impairments. Due to the negative results of a clinical trial, the extensive resources required and the high incidence of side effects, low frequency positive pressure ventilation ECCO(2)R was restricted to a 'rescue' therapy for the most severe case of acute respiratory distress syndrome (ARDS). Technological improvement led to the implementation of two different CO(2) removal approaches: the iLA called 'pumpless arteriovenous ECMO' and the veno-venous ECCO(2)R. They enable consideration of extracorporeal support as something more than mere rescue therapy; both of them are indicated in more protective ventilation settings in case of severe ARDS, and as a support to the spontaneous breathing/lung function in bridge to lung transplant. The future development of more and more efficient devices capable of removing a substantial amount of carbon dioxide production (30-100%) with blood flows of 250-500 ml/min is foreseeable. Moreover, in the future ARDS management should include a minimally invasive ECCO(2)R circuit associated with noninvasive ventilation. This would embody the modern mechanical ventilation philosophy: avoid tracheal tubes; minimize sedation, and prevent ventilator-induced acute lung injury and nosocomial infections.
Authors:
Pier Paolo Terragni; Alberto Birocco; Chiara Faggiano; V Marco Ranieri
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Publication Detail:
Type:  Journal Article     Date:  2010-04-20
Journal Detail:
Title:  Contributions to nephrology     Volume:  165     ISSN:  1662-2782     ISO Abbreviation:  Contrib Nephrol     Publication Date:  2010  
Date Detail:
Created Date:  2010-04-29     Completed Date:  2010-07-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513582     Medline TA:  Contrib Nephrol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  185-96     Citation Subset:  IM    
Copyright Information:
2010 S. Karger AG, Basel.
Affiliation:
Università di Torino, Dipartimento di Anestesia e di Medicina degli Stati Critici, Azienda Ospedaliera S. Giovanni Battista-Molinette, Torino, Italia.
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MeSH Terms
Descriptor/Qualifier:
Assisted Circulation / instrumentation,  methods
Carbon Dioxide / blood,  isolation & purification
Cardiopulmonary Bypass
Clinical Trials as Topic
Continuous Positive Airway Pressure / methods*
Equipment Design
Extracorporeal Membrane Oxygenation / methods*
Femoral Artery / physiopathology
Femoral Vein / physiopathology
Humans
Lung Diseases / therapy
Positive-Pressure Respiration / methods*
Respiratory Distress Syndrome, Adult / mortality,  therapy*
Survival Rate
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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