Hypercapnia in late-phase ALI/ARDS: providing spontaneous breathing using pumpless extracorporeal lung assist

Weber‐Carstens, Steffen; Bercker, Sven; Hommel, Matthias; Deja, Maria; MacGuill, Martin; Dreykluft, Christiane; Kaisers, Udo X.

doi:10.1007/s00134-009-1426-3

Cited by 25 publications

(19 citation statements)

References 27 publications

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“…In total, 14 studies were included: two RCTs (Table 1) [18,19], and six prospective observational studies [20-25] and six retrospective studies [26-31] (Table 2). The earliest study dated from 1986 and the most recent from 2013.…”

Section: Reviewmentioning

confidence: 99%

“…Five studies (two RCTs and three retrospective studies) reported ICU length of stay [18,19,26,27,29]. Neither RCT demonstrated a significant reduction in ICU length of stay.…”

Section: Reviewmentioning

confidence: 99%

“…The PaO 2 /FiO 2 ratio increased in all but three studies [19,24,25]. Carbon dioxide removal was quantitatively possible using strategies of arteriovenous carbon dioxide removal [19,21,26,29] (Table 4). …”

Section: Reviewmentioning

confidence: 99%

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Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

et al. 2014

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Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO2R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO2R devices. We included randomised controlled trials (RCTs), case–control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO2R was used in seven studies, and venovenous ECCO2R in seven studies. Available evidence suggests no mortality benefit to ECCO2R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCO2R. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO2R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed.

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Section: Reviewmentioning

confidence: 99%

“…Five studies (two RCTs and three retrospective studies) reported ICU length of stay [18,19,26,27,29]. Neither RCT demonstrated a significant reduction in ICU length of stay.…”

Section: Reviewmentioning

confidence: 99%

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Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

et al. 2014

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“…Pumpless arteriovenous extracorporeal lung assist (pECLA) is used increasingly in trauma patients. 14,15 The highly effective CO 2 elimination via pECLA allows separation of ventilation from oxygenation. The required mean airway pressure as the main determinant for oxygenation can be maintained with a respiratory pressure amplitude that is significantly reduced, especially if pE-CLA is combined with HFOV.…”

mentioning

confidence: 99%

Delayed systemic air embolism in a child with severe blunt chest trauma treated with high-frequency oscillatory ventilation

Brederlau

Muellenbach

Wunder

et al. 2011

Can J Anesth/J Can Anesth

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Purpose Trauma is the leading cause of death in children over one year of age. Even with optimal field care, blunt chest trauma with hemoptysis is a potentially fatal injury due to exsanguination or arterial air embolism. Most often, cardiovascular collapse that is unresponsive to therapy develops shortly after endotracheal intubation and initiation of positive pressure ventilation. We present a case of arterial air embolism after blunt chest trauma that manifested atypically late, i.e., one hour after initiation of positive pressure ventilation. Clinical features A 13-yr-old Caucasian boy was admitted to the emergency room after he had been run over by a car. While lung protective ventilation, including high frequency oscillatory ventilation, was performed, an alveolar to pulmonary venous fistula developed. Although the complication was diagnosed quickly, involvement of the cerebral and coronary arteries resulted in irreversible cerebral damage and fatal hemodynamic collapse.Necropsy confirmed severe damage of the right pulmonary lower lobe with involvement of the pulmonary vessels. Conclusion Patients with blunt chest trauma and hemoptysis present a diagnostic dilemma with limited therapeutic options. RésuméObjectif Les traumatismes sont la principale cause de de´ce`s chez les enfants aˆge´s de plus d'un an. Meˆme avec des soins optimaux sur le terrain, les traumatismes ferme´s du thorax accompagne´s d'he´moptysie constituent des le´sions potentiellement fatales en raison de l'exsanguination ou de l'embolie gazeuse arte´rielle. La plupart du temps, une de´faillance cardiovasculaire ne re´pondant pas au traitement se manifeste peu apre`s l'intubation endotrache´ale et l'amorce de la ventilation en pression positive. Nous pre´sentons un cas d'embolie gazeuse arte´rielle apre`s un traumatisme ferme´du thorax qui s'est de´veloppe´e exceptionnellement tard, soit une heure apre`s l'amorce de la ventilation en pression positive. É léments cliniques Un garçon d'origine caucasienne de 13 ans a e´te´admis a`l'urgence apre`s avoir e´te´happe´par une voiture. Pendant qu'une ventilation protectrice, y compris une ventilation oscillatoire a`haute fre´quence, e´tait re´alise´e, une fistule alve´oles-veines pulmonaires est apparue. Bien que cette complication ait e´te´rapidement de´piste´e, l'atteinte des arte`res ce´re´brales et coronaires a provoque´des le´sions ce´re´brales irre´versibles et un collapsus he´modynamique fatal. L'autopsie a confirme´la pre´sence de graves le´sions au niveau du lobe infe´rieur du poumon droit et des vaisseaux pulmonaires. Conclusion Les patients atteints de traumatismes ferme´s du thorax et d'he´moptysie pre´sentent un dilemme

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“…Bisher wurden die Verfahren fast ausschließlich bei ARDS-Patienten unter kontrollierter Beatmung verwendet. In einzelnen Fallserien konnte gezeigt werden, dass die Verfahren auch an wachen Patienten effektiv sind und über die Elimination des CO 2 die Atemlast der Patienten reduziert und der Anteil der Spontanatmung verbessert[154] werden. Aktuell werden neuere veno-venöse Systeme mit kleineren Pumpen entwickelt, die trotz geringerer Flussraten effektiv CO2 auswaschen.…”

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COPD und Infektion

Bals¹,

Gillissen²,

Lorenz³

et al. 2010

Pneumologie

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Infections are frequent and important causes of exacerbations in patients with COPD. This article reviews underlying mechanisms and therapeutic consequences. A complex interaction exists between COPD, co-morbidities, physical inactivity and systemic inflammation. The components of the postulated chronic inflammatory systemic syndrome need to be identified in more detail; physical inactivity seems to be the least common denominator. The patient's adaptive and innate immune systems play a role for the pathogenesis of infections. When interpreting positive bacterial cultures, it is important to differentiate between colonisation and infection. The impact of viral infections in COPD exacerbation needs further clarification, including the task to distinguish acute infection from viral persistence. Community acquired pneumonias pose a special risk for patients with COPD. Clinical scores and procalcitonin serum concentrations can support decisions on whether or not to start antibiotic treatment. Antibiotics probably do not need to be taken for longer than 5 days, since their efficacy does not increase after longer treatment, while adverse events rise in frequency. Hospitalisations for respiratory exacerbations are associated with increased mortality in COPD.

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Hypercapnia in late-phase ALI/ARDS: providing spontaneous breathing using pumpless extracorporeal lung assist

Cited by 25 publications

References 27 publications

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

Delayed systemic air embolism in a child with severe blunt chest trauma treated with high-frequency oscillatory ventilation

COPD und Infektion

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