Extracorporeal life support for adults with acute respiratory distress syndrome

被引：0
作者：
Alain Combes
Matthieu Schmidt
Carol L. Hodgson
Eddy Fan
Niall D. Ferguson
John F. Fraser
Samir Jaber
Antonio Pesenti
Marco Ranieri
Kathryn Rowan
Kiran Shekar
Arthur S. Slutsky
Daniel Brodie
机构：
[1] Institute of Cardiometabolism and Nutrition,Sorbonne Université, INSERM, UMRS_1166
[2] APHP Sorbonne Université Hôpital Pitié–Salpêtrière,ICAN
[3] Monash University,Service de Médecine Intensive
[4] University of Toronto,Réanimation, Institut de Cardiologie
[5] University Health Network,Australian and New Zealand Intensive Care
[6] University Health Network,Research Centre
[7] University of Toronto,Interdepartmenal Division of Critical Care Medicine
[8] The Prince Charles Hospital,Department of Medicine, Division of Respirology
[9] University of Queensland,Department of Medicine, Division of Respirology
[10] From the PhyMedExp,Interdepartmental Division of Critical Care Medicine and Department of Medicine
[11] University of Montpellier,Critical Care Research Group, Adult Intensive Care Services, Northside Medical School
[12] Centre Hospitalier Universitaire (CHU) Montpellier,Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)
[13] Hôpital Saint-Eloi,Département d’Anesthésie
[14] Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico,Réanimation
[15] University of Milan,Department of Anesthesia, Critical Care and Emergency, Department of Pathophysiology and Transplantation
[16] Alma Mater Studiorum University of Bologna,Intensive Care Unit, Policlinico di Sant’Orsola
[17] Clinical Trials Unit,Adult Intensive Care Services, Critical Care Research Group
[18] Intensive Care National Audit and Research Centre (ICNARC),Interdepartmental Division of Critical Care Medicine
[19] the Prince Charles Hospital,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto
[20] Queensland University of Technology,Division of Pulmonary, Allergy, and Critical Care Medicine
[21] University of Queensland,Center for Acute Respiratory Failure
[22] University of Toronto,undefined
[23] St Michael’s Hospital,undefined
[24] Columbia University College of Physicians and Surgeons,undefined
[25] NewYork-Presbyterian Hospital,undefined
[26] NewYork-Presbyterian Hospital,undefined
来源：
Intensive Care Medicine | 2020年 / 46卷
关键词：
Acute respiratory failure; Extracorporeal membrane oxygenation; Mechanical ventilation; Outcome;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
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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页码：2464 / 2476
页数：12
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