Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventila-tory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to he-modialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.
Carbon dioxide dialysis will save the lung / A. Pesenti, N. Patroniti, R. Fumagalli. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - 38:10 suppl.(2010 Oct), pp. S549-S554. ((Intervento presentato al convegno Conference on Thinking Outside the Box tenutosi a Bruxelles nel 2010 [10.1097/CCM.0b013e3181f1fe0c].
Carbon dioxide dialysis will save the lung
A. PesentiPrimo
;
2010
Abstract
Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventila-tory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to he-modialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.File | Dimensione | Formato | |
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