Extracorporeal life support for adults with acute respiratory distress syndrome.
Extracorporeal life support for adults with acute respiratory distress syndrome.
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DOI：
10.1007/s00134-020-06290-1
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发表时间：
2020-12
影响因子：
38.9
通讯作者：
Brodie D
中科院分区：
文献类型：
--
作者：
Combes A;Schmidt M;Hodgson CL;Fan E;Ferguson ND;Fraser JF;Jaber S;Pesenti A;Ranieri M;Rowan K;Shekar K;Slutsky AS;Brodie D
体外生命支持 (ECLS) 可以支持急性呼吸窘迫综合征 (ARDS) 患者的气体交换。在 ECLS 期间，静脉血通过插管从中央静脉排出，泵入允许氧气和二氧化碳扩散的半透膜，并通过插管返回到中央静脉。使用两种相关形式的 ECLS。静脉-静脉体外膜肺氧合 (ECMO) 使用高血流速率为血液充氧并去除二氧化碳，对于采用最佳实践传统机械通气和辅助治疗（包括俯卧位）无法充分维持氧合或通气的严重 ARDS 患者，可以考虑进行静脉静脉体外膜肺氧合 (ECMO)。体外二氧化碳去除 (ECCO2R) 通过较小的插管使用较低的血流速率，并可大量消除二氧化碳（约占二氧化碳总产量的 20-70%），尽管氧合作用略有改善。在 ARDS 中使用 ECCO2R 的基本原理是通过减少机械呼吸机提供的潮气量、呼吸频率、平台压、驱动压力和机械功率来促进肺保护性通气。这篇叙述性综述总结了与 ECLS 相关的生理学概念，以及支持 ECMO 和 ECCO2R 治疗 ARDS 的基本原理和证据。它还回顾了 ECLS 治疗患者可能出现的并发症、局限性和伦理困境。最后，讨论了该技术未来的关键研究问题和挑战。
Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO2R) uses lower blood flow rates through smaller cannulae and provides substantial CO2 elimination (~ 20–70% of total CO2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO2R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.
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DOI：
10.1186/cc13746
发表时间：
2014-02-27
期刊：
Critical care (London, England)
影响因子：
--
作者：
Abrams D;Javidfar J;Farrand E;Mongero LB;Agerstrand CL;Ryan P;Zemmel D;Galuskin K;Morrone TM;Boerem P;Bacchetta M;Brodie D
通讯作者：
Brodie D
影响因子：
38.9
作者：
Bein, Thomas;Weber-Carstens, Steffen;Goldmann, Anton;Mueller, Thomas;Staudinger, Thomas;Brederlau, Joerg;Muellenbach, Ralf;Dembinski, Rolf;Graf, Bernhard M.;Wewalka, Marlene;Philipp, Alois;Wernecke, Klaus-Dieter;Lubnow, Matthias;Slutsky, Arthur S.
通讯作者：
Slutsky, Arthur S.
影响因子：
8.8
作者：
Aubron, Cecile;McQuilten, Zoe;Cooper, D. James
通讯作者：
Cooper, D. James
影响因子：
8.8
作者：
Abrams, Darryl;Pham, Tai;Ranieri, V. Marco
通讯作者：
Ranieri, V. Marco
影响因子：
8.8
作者：
Crotti, Stefania;Bottino, Nicola;Gattinoni, Luciano
通讯作者：
Gattinoni, Luciano