A New Look at Therapy of the Adult Respiratory Distress Syndrome

Gattinoni, Luciano; Pesenti, Antonio; Kolobow, Theodor; Damia, G

doi:10.1097/00004311-198308000-00008

Cited by 55 publications

(29 citation statements)

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“…The fact that O 2 is carried in the blood, chiefly bound to hemoglobin, and considering that venous blood has high mixed venous oxygen saturation of 65–70%, there is a limit to the additional amount of O 2 that can be bound to hemoglobin when blood perfuses the natural lungs or extracorporeal membrane lungs. Thus, it is important to highlight that oxygenation is highly dependent on blood flow and consequently, blood flow in the range of 4–6 liters is essential for effective oxygenation to meet the metabolic demands [18,19]. …”

Section: The Basis Of Extracorporeal Lung Supportmentioning

confidence: 99%

“…Secondly, as CO 2 is highly diffusible, high efficiency of elimination can be achieved by ensuring high gas flow rates to maximize the diffusive CO 2 gradient between the blood and gas interfaces of the membrane (lung or extracorporeal). Hence, in contrast to oxygenation, CO 2 transport is primarily ventilation or gas flow dependent and effective elimination of CO 2 can be achieved at relatively slow blood flow rates [18,19]. …”

Section: The Basis Of Extracorporeal Lung Supportmentioning

confidence: 99%

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Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Kaushik

Wojewódzka-Żelezniakowicz

Cruz

et al. 2012

Blood Purif

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Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field.

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Section: The Basis Of Extracorporeal Lung Supportmentioning

confidence: 99%

Section: The Basis Of Extracorporeal Lung Supportmentioning

confidence: 99%

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Kaushik

Wojewódzka-Żelezniakowicz

Cruz

et al. 2012

Blood Purif

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“…In a healthy man, 2.5 L of alveoli receive 5 to 7.5 L of ventilation each minute (ratio, 2.5). In our ARDS patient, a "baby lung" (7) amounting to just 0.5 L of open alveoli receives 12.5 to 15 L per minute (ratio, [25][26][27][28][29][30], pumped under pressure by the mechanical ventilator. If this simplified model makes any sense, then each open respiratory unit of the ARDS lung receives 25-to 30-times the mechanical stress the normal lung is receiving.…”

Section: Consider the Concept Of Specific Hyperventilationmentioning

confidence: 99%

“…The physiologic requirements of oxygenation and CO 2 removal are opposite (27). Oxygen is carried in blood bound to hemoglobin, and the maximum content of oxygen is defined by the equation CaO 2 ϭ 0.0139 ϫ hemoglobin ϫ SaO 2 ϩ 0.003 ϫ PaO 2 (mLO 2 /dL).…”

Section: Extracorporeal Co 2 Removal Versus Ecmomentioning

confidence: 99%

Carbon dioxide dialysis will save the lung

Pesenti

Patroniti

2010

Critical Care Medicine

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Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventilatory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to hemodialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.

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“…The methodology pf extracorporeal CÖ 2 removai is described in detail elsewhere (22)(23)(24) Quantilies of pulmonary function and haemodynamics On each day of extracorporeal CO 2 removal treatment the pulmonary function was assessed by a sei of repräsentative Parameters. The intrapulmonal right-left shunt (Qs/Qr), alveolo-arterial oxygen pressure difference, mean pulmonary arterial pressure, and cardiac outpul were determined by Standard techniques.…”

Section: Extracorporeal Co 2 Removalmentioning

confidence: 99%

The Prognostic Value of Extracellular Matrix Component Concentrations in Serum During Treatment of Adult Respiratory Distress Syndrome with Extracorporeal CO2 Removal

Kropf¹,

Grobe²,

Knoch³

et al. 1991

Clinical Chemistry and Laboratory Medicine

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Summary:The time-dependent concentrations of hyaluronan, aminoterminal propeptide of type III procollagen, and laminin were determined in sera of 16 patients with severe adult respiratory distress syndrome during treatment with an extracorporeal CO 2 removal device. Patients were classified according to lung Parameters äs responders (n = 10) and non-responders (n = 6) to extracorporeal CO 2 removal. At the beginning of treatment strongly elevated serum concentrations of all studied extracellular matrix components were found. During the first 6-11 days of treatment the concentrations of aminoterminal propeptide of type III procollagen and hyaluronan increased further in non-responders but decreased in the majority of responders, while laminin decreased in both groups. No significant correlations were found between the serum concentrations of connective tissue components and the parameters of lung function. By non-parametric analysis of variance, significant differences between responders and non-responders according to treatment time could be established. By analysing the time course of the serum concentrations of hyaluronan and aminoterminal propeptide of type III procollagen, a total differentiation between responders and nonresponders was made pössible by the trends of these analytes äs early äs three days after the Start of treatment. The determination of aminoterminal propeptide of type III procollagen and hyaluronan in serum of patients with adult respiratory distress syndrome might therefore have prognostic significance in extracorporeal CO 2 removal. unfavourable rapid development of pulmonary fibroThe adult respiratory distress syndrome is a severe sis within about 2 weeks (5, 6), characterized by an condition of life-threatening organ failure, character-increase in fibroblast numbers and accelerated collaized by tachypnoea, hypoxaemia, diffuse interstitial gen metabolism (7,8). mfiltrates, alveolar oedema, and loss of lung compliance (l, 2). The syndrome develops in response to a Components of the extracellular matrix have been primary attack on lung cells like inhalation of toxins, determined in blood of patients with fibrotic lung aspiration of gastric contents (3) or äs a consequence diseases, but in contrast to e. g. liver fibrosis there of systemicdisorders like septicshock and multiorgan seems to be only a weak association between the trauma. Severe, progressive cases are associated with concentrations of such analytes in blood and the a mortality rate of up to 90% (4). One sequel of adult activity and/or grade of the fibrosing process in the respiratory distress syndrome is the prognostically lung (9).

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A New Look at Therapy of the Adult Respiratory Distress Syndrome

Cited by 55 publications

References 0 publications

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Carbon dioxide dialysis will save the lung

The Prognostic Value of Extracellular Matrix Component Concentrations in Serum During Treatment of Adult Respiratory Distress Syndrome with Extracorporeal CO2 Removal

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