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ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions

  • Chapter
Extracorporeal Life Support for Adults

Part of the book series: Respiratory Medicine ((RM,volume 16))

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Abstract

Extracorporeal carbon dioxide removal (ECCO2R) utilizes the fact that it is simpler to clear the blood of CO2 than to oxygenate it. The entire metabolic production of CO2 can often be removed with relatively low blood flows, and accordingly smaller cannulas and simpler equipment. In ARDS, when oxygenation is also challenged, ECCO2R serves to reduce ventilatory demand, allowing lower tidal volumes, better protecting the lung. In obstructive diseases, since oxygenation is usually only modestly impaired, ECCO2R could help to liberate patients from invasive mechanical ventilation or prevent its need in the first place. In patients with chronic obstructive pulmonary disease (COPD) and status asthmaticus, ECCO2R has been shown to improve gas exchange, reduce the work of breathing, reduce dynamic hyperinflation, and allow reduction in ventilatory support. Although certain risks attend ECCO2R use, it also may have advantages compared with invasive ventilation. Clinical trials are needed to define the role for ECCO2R.

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Funding

Ministero della Salute, Programma Ricerca Finalizzata # VMR23a/2004-2006, Regione Piemonte, Programma Ricerca Finalizzata # CIPE LM002/2005-2007, Ministero dell’Università, Programmi di Ricerca di Interesse Nazionale # VMRLM98, 2007-2010.

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Authors and Affiliations

  1. Dipartimento di Anestesiologia e Rianimazione, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Università di Torino, Torino, Italy

    Lorenzo Del Sorbo MD & V. Marco Ranieri MD

  2. Inter-departmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, ON, Canada

    Lorenzo Del Sorbo MD

  3. Dipartimento di Anestesiologia e Medicina degli Stati Critici, Ospedale S. Giovanni Battista-Molinette, Università di Torino, Corso Dogliotti 14, 10126, Torino, Italy

    V. Marco Ranieri MD

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  1. Lorenzo Del Sorbo MD
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Correspondence to V. Marco Ranieri MD .

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Editors and Affiliations

  1. Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Department of Internal Medicine, Iowa City, Iowa, USA

    Gregory A Schmidt

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Del Sorbo, L., Ranieri, V.M. (2016). ECCO2R in Obstructive Diseases: Evidence, Indications, and Exclusions. In: Schmidt, G. (eds) Extracorporeal Life Support for Adults. Respiratory Medicine, vol 16. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3005-0_4

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  • DOI: https://doi.org/10.1007/978-1-4939-3005-0_4

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