The Place of Extracorporeal CO2 Removal in the Treatment of ARDS

  • F. Brunet
  • J. Dall’Ava-Santucci
  • J. F. Dhainaut
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1992)

Abstract

Extracorporeal CO2 removal (ECCO2R) in combination with low-frequency positive ventilation was recently introduced in the treatment of patients suffering from adult respiratory distress syndrome (ARDS), with an improved survival rate in the first report from Gattinoni et al. [1]. This method is performed with extracorporeal membrane oxygenators similar to those used for ECMO, which failed to improve survival in adults with ARDS [2]. The goal of both techniques is similar, i.e. to provide favorable conditions for the lung to recover, but the means are different. ECMO supplied the whole needs of the organism and achieved complete oxygenation and CO2 elimination by an arterio-venous bypass with lung membrane oxygenators. In ECCO2R, CO2 elimination by veno-venous bypass, aimed at reducing the lung injury induced by high volume-high pressure ventilation, while arterial oxygenation was achieved mainly by pseudo-apneic ventilation [3]. The better efficacy of ECCO2R in ARDS patients [4] could be explained either by a lower complications rate with veno-venous bypass than with ECMO, or by differences in pulmonary management between the two methods of extracorporeal assistance. The ECMO study used conventional mechanical ventilation associated with bypass, and did not allow a reduction in peak pressures, respiratory rates and tidal volumes of the ventilator. Deleterious effect of mechanical ventilation on severely injured lungs, also named pulmonary barotrauma, was controversial until recently [5], but has been clearly established in animal models [6, 7] and is now well accepted [8], The goal of ECCO2R was to allow pseudoapneic ventilation and subsequently to decrease respiratory rate, tidal volume and peak pressures to reduce the risk of overinflation of inhomogeneously injured lungs [4].

Keywords

Permeability Toxicity Catheter Dioxide Albumin 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • F. Brunet
  • J. Dall’Ava-Santucci
  • J. F. Dhainaut

There are no affiliations available

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