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Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2015

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

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Abstract

Mechanical ventilation remains the cornerstone of respiratory support for patients with acute respiratory failure. However, high pressure and volume associated with tidal ventilation are known to aggravate lung injury in this setting [1]. Furthermore, profound gas-exchange abnormalities threatening patients’ lives can occur in the most severe forms of the disease despite recourse to conventional salvage therapies [2, 3]. Extracorporeal gas exchange devices, i. e., venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), were developed more than 40 years ago [4, 5] to rescue these dying patients. Whereas venovenous ECMO provides complete extracorporeal blood oxygenation and decarboxylation using high blood flows (4–6 l/min) and large (20–30 Fr) cannulas [6–9], efficient extracorporeal CO2 removal (with minimal blood oxygenation) can be achieved with ECCO2R devices using limited extracorporeal blood flow (0.4–1 l/min) and thin double lumen venous catheters (14–18 Fr) [10, 11], because CO2 clearance is more effective than oxygenation due to the greater solubility and more rapid diffusion of CO2 [12]. Extracorporeal gas exchange devices also permit ‘ultraprotective’ mechanical ventilation with further reduction of volume and pressure, which may ultimately enhance lung protection and improve clinical outcomes for patients with acute respiratory distress syndrome (ARDS). However, results of trials evaluating extracorporeal gas exchange for respiratory failure performed in the 1970s, 80s and 90s were often disappointing [13, 14]. In recent years, major technological advances have occurred and the latest generation extracorporeal gas exchange devices, with polymethylpentene hollow-fiber membrane lungs and Mendler-designed centrifugal pumps offer lower resistance to blood flow, have smaller priming volumes, higher effective gas exchange properties and are coated with more biocompatible materials.

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  1. Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France

    M. Schmidt & A. Combes

  2. The Australian & New Zealand Intensive Care Research Centre and the Intensive Care Department, Alfred Hospital, Melbourne, Australia

    C. Hodgson

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    Jean-Louis Vincent Prof.

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Schmidt, M., Hodgson, C., Combes, A. (2015). Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_14

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