Low-Frequency Positive-Pressure Ventilation With Extracorporeal CO2 Removal in Severe Acute Respiratory Failure

Gattinoni, Luciano; Pesenti, Antonio; Mascheroni, D.; Marcolin, R; Fumagalli, Roberto; Rossi, Fabiana; Iapichino, G.; Romagnoli, G; Uziel, Lilj; Agostoni, A

doi:10.1001/jama.1986.03380070087025

Cited by 573 publications

(101 citation statements)

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“…The rationale of their advanced technique was to prevent further damage to the diseased lungs by reducing their motion (pulmonary rest) with application of only a few ventilator breaths with low V T and low peak inspiratory pressures. This lung protective mechanical ventilation strategy became known as low-frequency positive-pressure ventilation (LFPPV) [30]. With this method, oxygen uptake and carbon dioxide removal were dissociated.…”

Section: Historymentioning

confidence: 99%

“…The so-called LFPPV-ECCO 2 -R technique was performed at low extracorporeal blood flows (20-30% of cardiac output), so that a venovenous bypass technique instead of an arteriovenous one sufficed, which turned out to be less detrimental to blood cells, coagulation and internal organs. Using LFPPV-ECCO 2 -R, Gattinoni et al [30] reported survival rates of up to 49%. In the following years several centres corroborated the promising survival rates of around 50% and higher (Fig.…”

Section: Historymentioning

confidence: 99%

“…Gattinoni et al [30] found a survival rate of 49% in 1986. Through July 1995, the Extracorporeal Life Support Organization Register in Ann Arbor, Michigan, USA recorded an overall survival rate of 41% in 197 adult ARDS patients treated with extracorporeal respiratory support [57].…”

Section: Outcome From Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

“…The data support the view that survival rates in both treatment groups followed a positive trend. Data have been taken from [1,5,8,9,10,12,13,14,15,30,31,39,43,55, 56,63,64,91,92,95,96,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130]. …”

Section: Outcome From Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

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Lewandowski

2000

Crit Care

146

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Extracorporeal membrane oxygenatioon (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass technique and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The initial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over convential treatment, survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered and will need evaluation by a future RCT.Keywords: acute respiratory distress syndrome, adults, children, complications, extracorporeal membrane oxygenation, follow up, history, lung protective mechanical ventilation, mortality rates, technology The electronic version of this article can be found online at http://ccforum.com/content/4/3/156 © Current Science Ltd ARDS = acute respiratory distress syndrome; ECCO 2 -R = extracorporeal carbon dioxide removal; ECMO = extracorporeal membrane oxygenation; LFPPV = low-frequency positive-pressure ventilation; NO = nitric oxide; PEEP = positive end-expiratory pressure; PPHN = persistent pulmonary hypertension; RCT = randomized controlled trial; V T = tidal volume.

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Section: Historymentioning

confidence: 99%

Section: Historymentioning

confidence: 99%

Section: Outcome From Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Section: Outcome From Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

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Lewandowski

2000

Crit Care

146

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“…: ECM021 ^1:^* oji1 brane gas exchange device)2] "-i] "An 4* 514. [6] ^*) iLAfe û oll - §-0)401 ARDSo1)4 IE)) Ü^Et^S 01:7)51 * èl)a:*>AS«l 2)-£*t *4* ûl)«]-4o^ VILI* to)fe 11 …”

mentioning

confidence: 99%

A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report -

Cho

Seo

Kim

et al. 2012

Korean J Crit Care Med

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Pumpless extraeorporeal interventional lung assist (iLA) is a promising respiratory rescue system permitting protective lung ventilation for severe respiratory failure. Herein, we report a case of prolonged iLA support with regards to a patient exhibiting severe hypercapnic respiratory failure. A 51-year-old female patient with metastatic endometrial carcinoma developed progressive hospital-acquired pneumonia and was intubated in order to restore respiratory failure. Despite maximal mechanical ventilator care, her clinical condition deteriorated due to severe respiratory acidosis. The iLA was performed for the management of refractory hypercapnia. The total duration of iLA support was 23 days without any vascular complications, however, she could not survive because of oxygénation failure.

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Pathogenesis and Treatment of the Adult Respiratory Distress Syndrome

et al. 1996

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The adult respiratory distress syndrome is an acute clinical illness characterized by noncardiogenic pulmonary edema and refractory hypoxemia. Injury to the alveolar-capillary barrier and lung inflammation lead to intrapulmonary shunting of blood, surfactant depletion, and pulmonary vascular obstruction. Numerous mediators contribute to the pathologic response. Conventional therapy includes treating underlying causes and positive pressure mechanical ventilation. Concern about pressure-induced lung injury had led to new strategies to accomplish adequate gas exchange. Novel therapeutic interventions have included extracorporeal support techniques, use of compounds designed to neutralize proinflammatory cytokines, and administration of surfactants, but these efforts have not definitely affected mortality in randomized trials. Potent antioxidant agents have shown promise in animal models of acute lung injury, but human studies are lacking. Inhaled nitric oxide appears to have temporary effects on pulmonary artery pressure and on ventilation or perfusion relationships, but longer-term efficacy and safety in patients suffering from adult respiratory distress syndrome is unknown and awaits results of ongoing clinical trials.

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Low-Frequency Positive-Pressure Ventilation With Extracorporeal CO2 Removal in Severe Acute Respiratory Failure

Cited by 573 publications

References 17 publications

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A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report -

Pathogenesis and Treatment of the Adult Respiratory Distress Syndrome

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