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Extracorporeal co2 removal

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https://www.readbyqxmd.com/read/29019893/rescue-therapeutic-strategy-combining-ultra-protective-mechanical-ventilation-with-extracorporeal-co2-removal-membrane-in-near-fatal-asthma-with-severe-pulmonary-barotraumas-a-case-report
#1
Arthur Pavot, Jihad Mallat, Nicolas Vangrunderbeeck, Didier Thevenin, Malcolm Lemyze
RATIONALE: Mechanical ventilation of severe acute asthma is still considered a challenging issue, mainly because of the gas trapping phenomenon with the potential for life-threatening barotraumatic pulmonary complications. PATIENT CONCERNS: Herein, we describe 2 consecutive cases of near-fatal asthma for whom the recommended protective mechanical ventilation approach using low tidal volume of 6 mL/kg and small levels of PEEP was rapidly compromised by giant pneumomediastinum with extensive subcutaneousemphysema...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28979565/protective-ventilation-with-veno-venous-lung-assist-in-respiratory-failure-a-protocol-for-a-multicentre-randomised-controlled-trial-of-extracorporeal-carbon-dioxide-removal-in-patients-with-acute-hypoxaemic-respiratory-failure
#2
J J McNamee, M A Gillies, N A Barrett, A M Agus, R Beale, A Bentley, A Bodenham, S J Brett, D Brodie, S J Finney, A J Gordon, M Griffiths, D Harrison, C Jackson, C McDowell, C McNally, G D Perkins, W Tunnicliffe, A Vuylsteke, T S Walsh, M P Wise, D Young, D F McAuley
One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO2R in patients with acute hypoxaemic respiratory failure...
May 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28979541/management-of-severe-traumatic-brain-injury-and-acute-respiratory-distress-syndrome-using-pumped-extracorporeal-carbon-dioxide-removal-device
#3
Tim Martindale, Phillip McGlone, Robert Chambers, Jon Fennell
The effects of a high carbon dioxide on cerebral perfusion and intracranial pressure are well known. We report the case of a man who presented after with a severe traumatic brain injury including intracranial and extradural haemorrhage. Neuroprotective ventilation was impossible without supramaximal tidal volumes due to a combination of chest trauma and severe bronchospasm. A pump driven Novalung iLA active® system was inserted to achieve both ARDSnet ventilation and a lowering of intracranial pressure. To our knowledge, this is the first time this system has been used to this effect...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28930639/50-years-of-research-in-ards-tidal-volume-selection-in-the-acute-respiratory-distress-syndrome
#4
Sarina K Sahetya, Jordi Mancebo, Roy G Brower
Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Since the publication of a large randomized clinical trial demonstrating the benefit of lower tidal volumes, the use of tidal volumes of 6 mL/kg predicted body weight (PBW, based on sex and height) has been recommended in clinical practice guidelines...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28921478/interstitial-pneumonia-with-autoimmune-features-an-additional-risk-factor-for-ards
#5
Giacomo Grasselli, Beatrice Vergnano, Maria Rosa Pozzi, Vittoria Sala, Gabriele D'Andrea, Vittorio Scaravilli, Marco Mantero, Alberto Pesci, Antonio Pesenti
BACKGROUND: Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period...
September 18, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28914339/do-we-need-randomized-clinical-trials-in-extracorporeal-respiratory-support-yes
#6
EDITORIAL
Alain Combes, Antonio Pesenti, Daniel Brodie
Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases...
September 15, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28875449/an-extracorporeal-carbon-dioxide-removal-ecco2r-device-operating-at-hemodialysis-blood-flow-rates
#7
R Garrett Jeffries, Laura Lund, Brian Frankowski, William J Federspiel
BACKGROUND: Extracorporeal carbon dioxide removal (ECCO2R) systems have gained clinical appeal as supplemental therapy in the treatment of acute and chronic respiratory injuries with low tidal volume or non-invasive ventilation. We have developed an ultra-low-flow ECCO2R device (ULFED) capable of operating at blood flows comparable to renal hemodialysis (250 mL/min). Comparable operating conditions allow use of minimally invasive dialysis cannulation strategies with potential for direct integration to existing dialysis circuitry...
September 6, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28828367/spontaneous-breathing-a-double-edged-sword-to-handle-with-care
#8
REVIEW
Tommaso Mauri, Barbara Cambiaghi, Elena Spinelli, Thomas Langer, Giacomo Grasselli
In acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) patients, spontaneous breathing is associated with multiple physiologic benefits: it prevents muscles atrophy, avoids paralysis, decreases sedation needs and is associated with improved hemodynamics. On the other hand, in the presence of uncontrolled inspiratory effort, severe lung injury and asynchronies, spontaneous ventilation might also worsen lung edema, induce diaphragm dysfunction and lead to muscles exhaustion and prolonged weaning...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828362/tidal-volume-in-acute-respiratory-distress-syndrome-how-best-to-select-it
#9
REVIEW
Michele Umbrello, Antonella Marino, Davide Chiumello
Mechanical ventilation is the type of organ support most widely provided in the intensive care unit. However, this form of support does not constitute a cure for acute respiratory distress syndrome (ARDS), as it mainly works by buying time for the lungs to heal while contributing to the maintenance of vital gas exchange. Moreover, it can further damage the lung, leading to the development of a particular form of lung injury named ventilator-induced lung injury (VILI). Experimental evidence accumulated over the last 30 years highlighted the factors associated with an injurious form of mechanical ventilation...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28808576/-awake-ecco2r-superseded-intubation-in-a-near-fatal-asthma-attack
#10
Thomas-Michael Schneider, Tibor Bence, Franz Brettner
BACKGROUND: Near-fatal asthma attacks are life threatening events that often require mechanical ventilation. Extracorporeal carbon dioxide removal (ECCO2R) is, beside extracorporeal membrane oxygenation (ECMO), a well-established rescue option whenever ventilation gets to its limits. But there seems to be very rare experience with those techniques in avoiding mechanical ventilation in severe asthma attacks. CASE PRESENTATION: A 67-year-old man with a near-fatal asthma attack deteriorated under non-invasive ventilation conditions...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28795334/mathematical-modeling-of-extracorporeal-co2-removal-therapy-a-validation-carried-out-on-ten-pigs
#11
Simon Habran, Thomas Desaive, Philippe Morimont, Bernard Lambermont, Pierre Dauby
The extracorporeal CO2 removal device (ECCO2RD) is used in clinics to treat patients suffering from respiratory failures like acute respiratory distress syndrome (ARDS) or chronic obstructive pulmonary disease (COPD). The aim of this device is to decarboxylate blood externally with low blood flow. A mathematical model is proposed to describe protective ventilation, ARDS, and an extracorporeal CO2 removal therapy (ECCO2RT). The simulations are compared with experimental data carried out on ten pigs. The results show a good agreement between the mathematical simulations and the experimental data, which provides a nice validation of the model...
August 9, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/28766276/impact-of-membrane-lung-surface-area-and-blood-flow-on-extracorporeal-co2-removal-during-severe-respiratory-acidosis
#12
Christian Karagiannidis, Stephan Strassmann, Daniel Brodie, Philine Ritter, Anders Larsson, Ralf Borchardt, Wolfram Windisch
BACKGROUND: Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m(2). The present study in an animal model with similar CO2 production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO2R. METHODS: Four different membrane lungs, with varying lung surface areas of 0...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28754757/adjunctive-extracorporeal-carbon-dioxide-removal-in-refractory-status-asthmaticus
#13
Chuan Jiang, Jodi Galaydick, Harold Fernandez, Jonathan Caronia
Status asthmaticus (SA) is a life-threatening disorder. Severe respiratory failure may require extracorporeal membrane oxygenation (ECMO). Previous reports have demonstrated utility of ECMO in SA in various patients with varying success. A 25-year-old man was admitted with status asthmatics and severe hypercapnic respiratory failure. Despite tailored ventilator therapies, such as pressure control ventilation and maximal pharmacological therapy, including general anaesthesia, the patient’s condition deteriorated rapidly...
July 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28741663/carbon-dioxide-flush-of-an-integrated-minimized-perfusion-circuit-prior-to-priming-prevents-spontaneous-air-release-into-the-arterial-line-during-clinical-use
#14
Marco C Stehouwer, Roel de Vroege, Gerard J F Hoohenkerk, Frederik N Hofman, Johannes C Kelder, Bas Buchner, Bastian A de Mol, Peter Bruins
Recently, an oxygenator with an integrated centrifugal blood pump (IP) was designed to minimize priming volume and to reduce blood foreign surface contact even further. The use of this oxygenator with or without integrated arterial filter was compared with a conventional oxygenator and nonintegrated centrifugal pump. To compare the air removal characteristics 60 patients undergoing coronary artery bypass grafting were alternately assigned into one of three groups to be perfused with a minimized extracorporeal circuit either with the conventional oxygenator, the oxygenator with IP, or the oxygenator with IP plus integrated arterial filter (IAF)...
July 25, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28707030/-update-acute-hypercapnic-respiratory-failure
#15
REVIEW
F Seiler, F C Trudzinski, M Kredel, C Lotz, P M Lepper, R M Muellenbach
BACKGROUND: Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. OBJECTIVE: Summarizing the state of the art in the management of hypercapnic respiratory failure with special regard to the role of ECCO2R. METHODS: Review based on a selective literature search and the clinical and scientific experience of the authors...
July 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28702958/extracorporeal-co2-removal-a-powerful-tool-to-be-handled-with-care
#16
Giacomo Grasselli, Antonio Pesenti
No abstract text is available yet for this article.
July 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28643320/revised-protocol-of-extracorporeal-membrane-oxygenation-ecmo-therapy-in-severe-ards-recommendations-of-the-veno-venous-ecmo-expert-panel-appointed-in-february-2016-by-the-national-consultant-on-anesthesiology-and-intensive-care
#17
Romuald Lango, Zbigniew Szkulmowski, Dariusz Maciejewski, Andrzej Sosnowski, Krzysztof Kusza
Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28638160/low-flow-extracorporeal-carbon-dioxide-removal-using-the-hemolung-respiratory-dialysis-system-%C3%A2-to-facilitate-lung-protective-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#18
Bindu Akkanti, Keshava Rajagopal, Kirti P Patel, Sangeeta Aravind, Emmanuel Nunez-Centanu, Rahat Hussain, Farshad Raissi Shabari, Wayne L Hofstetter, Ara A Vaporciyan, Igor S Banjac, Biswajit Kar, Igor D Gregoric, Pranav Loyalka
Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28636403/applying-precision-medicine-to-trial-design-using-physiology-extracorporeal-co2-removal-for-acute-respiratory-distress-syndrome
#19
REVIEW
Ewan C Goligher, Marcelo B P Amato, Arthur S Slutsky
In clinical trials of therapies for acute respiratory distress syndrome (ARDS), the average treatment effect in the study population may be attenuated because individual patient responses vary widely. This inflates sample size requirements and increases the cost and difficulty of conducting successful clinical trials. One solution is to enrich the study population with patients most likely to benefit, based on predicted patient response to treatment (predictive enrichment). In this perspective, we apply the precision medicine paradigm to the emerging use of extracorporeal CO2 removal (ECCO2R) for ultraprotective ventilation in ARDS...
September 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28631461/extracorporeal-co2-removal-in-the-icu-an-effective-treatment-awaiting-proper-indications
#20
Jean-Michel Arnal, Aude Garnero
No abstract text is available yet for this article.
August 2017: Minerva Anestesiologica
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