Purpose of reviewAccumulating evidence ascribes the benefit of extracorporeal gas exchange, at least in most severe cases, to the provision of a lung healing environment through the mitigation of ventilator-induced lung injury (VILI) risk. In spite of pretty homogeneous criteria for extracorporeal gas exchange application (according to the degree of hypoxemia/hypercapnia), ventilatory management during extracorporeal membrane oxygenation (ECMO)/carbon dioxide removal (ECCO2R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support.Recent findingsAt present, the most common approach to protect the native lung against VILI following ECMO initiation involves lowering tidal volume and driving pressure, making modest reductions in respiratory rate, while typically maintaining positive end-expiratory pressure levels unchanged.Regarding ECCO2R treatment, higher efficiency devices are required in order to reduce significantly respiratory rate and/or tidal volume.SummaryThe best compromise between reduction of native lung ventilatory load, extracorporeal gas exchange efficiency, and strategies to preserve lung aeration deserves further investigation.

Ventilation during extracorporeal gas exchange in acute respiratory distress syndrome / J. Fumagalli, A. Pesenti. - In: CURRENT OPINION IN CRITICAL CARE. - ISSN 1070-5295. - 30:1(2024 Feb), pp. 69-75. [10.1097/MCC.0000000000001125]

Ventilation during extracorporeal gas exchange in acute respiratory distress syndrome

A. Pesenti
2024

Abstract

Purpose of reviewAccumulating evidence ascribes the benefit of extracorporeal gas exchange, at least in most severe cases, to the provision of a lung healing environment through the mitigation of ventilator-induced lung injury (VILI) risk. In spite of pretty homogeneous criteria for extracorporeal gas exchange application (according to the degree of hypoxemia/hypercapnia), ventilatory management during extracorporeal membrane oxygenation (ECMO)/carbon dioxide removal (ECCO2R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support.Recent findingsAt present, the most common approach to protect the native lung against VILI following ECMO initiation involves lowering tidal volume and driving pressure, making modest reductions in respiratory rate, while typically maintaining positive end-expiratory pressure levels unchanged.Regarding ECCO2R treatment, higher efficiency devices are required in order to reduce significantly respiratory rate and/or tidal volume.SummaryThe best compromise between reduction of native lung ventilatory load, extracorporeal gas exchange efficiency, and strategies to preserve lung aeration deserves further investigation.
acute respiratory distress syndrome; extracorporeal carbon dioxide removal; extracorporeal membrane oxygenation; mechanical ventilation
Settore MED/41 - Anestesiologia
feb-2024
Article (author)
File in questo prodotto:
File Dimensione Formato  
ventilation_during_extracorporeal_gas_exchange_in.11.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 232.16 kB
Formato Adobe PDF
232.16 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1048450
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact