conducted during very brief periods (only 2 h of respiratory electrodialysis), and that further complications may arise when performing the technique over clinically meaningful periods. Moreover, the technical setup is complex and will need to be as safe as possible before it can be deployed in human trials.
ConclusionsDuring the last decades, we have learned that the iatrogenic effects of invasive mechanical ventilation may negatively influence outcomes. Minimally invasive extracorporeal lung assist devices markedly reducing the need for alveolar ventilation would or could play a pivotal role in mitigating these negative influences.The innovative approach of Zanella and colleagues opens the possibility of ensuring sufficient CO 2 removal with a less-invasive way of using positive pressure ventilation than the current standard, or by eliminating invasive mechanical ventilation altogether. Doubling the amount of extracorporeal CO 2 removal would allow a considerable decrease in invasiveness by enabling lower flow rates and vascular access with smaller cannulae. Moreover, it offers the opportunity to widely apply and evaluate the concept of ultraprotective ventilation to reduce VILI, as well as a potential alternative to invasive mechanical ventilation for the support of hypercapnic respiratory failure. If the technique of Zanella and colleagues could be successfully transferred to the clinical setting, it might mark a quantum jump in the treatment of respiratory failure of different etiologies. n