急性呼吸窘迫综合征
肾脏替代疗法
医学
重症监护医学
急性呼吸窘迫
高碳酸血症
体外
机械通风
二氧化碳去除
呼吸性酸中毒
肺
麻醉
酸中毒
外科
内科学
二氧化碳
生物
生态学
作者
Francesca Cappadona,Elisa Costa,Laura Mallia,Filippo Sangregorio,Lorenzo Nescis,Valentina Zanetti,Elisa Russo,Stefania Bianzina,Francesca Viazzi,Pasquale Esposito
出处
期刊:Biomedicines
[MDPI AG]
日期:2023-01-05
卷期号:11 (1): 142-142
标识
DOI:10.3390/biomedicines11010142
摘要
Lung-protective ventilation (LPV) with low tidal volumes can significantly increase the survival of patients with acute respiratory distress syndrome (ARDS) by limiting ventilator-induced lung injuries. However, one of the main concerns regarding the use of LPV is the risk of developing hypercapnia and respiratory acidosis, which may limit the clinical application of this strategy. This is the reason why different extracorporeal CO2 removal (ECCO2R) techniques and devices have been developed. They include low-flow or high-flow systems that may be performed with dedicated platforms or, alternatively, combined with continuous renal replacement therapy (CRRT). ECCO2R has demonstrated effectiveness in controlling PaCO2 levels, thus allowing LPV in patients with ARDS from different causes, including those affected by Coronavirus disease 2019 (COVID-19). Similarly, the suitability and safety of combined ECCO2R and CRRT (ECCO2R–CRRT), which provides CO2 removal and kidney support simultaneously, have been reported in both retrospective and prospective studies. However, due to the complexity of ARDS patients and the limitations of current evidence, the actual impact of ECCO2R on patient outcome still remains to be defined. In this review, we discuss the main principles of ECCO2R and its clinical application in ARDS patients, in particular looking at clinical experiences of combined ECCO2R–CRRT treatments.
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