Abstract:
:Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO2R) uses lower blood flow rates through smaller cannulae and provides substantial CO2 elimination (~ 20-70% of total CO2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO2R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Combes A,Schmidt M,Hodgson CL,Fan E,Ferguson ND,Fraser JF,Jaber S,Pesenti A,Ranieri M,Rowan K,Shekar K,Slutsky AS,Brodie Ddoi
10.1007/s00134-020-06290-1subject
Has Abstractpub_date
2020-12-01 00:00:00pages
2464-2476issue
12eissn
0342-4642issn
1432-1238pii
10.1007/s00134-020-06290-1journal_volume
46pub_type
杂志文章,评审abstract:PURPOSE:To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients. METHODS:We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis incl...
journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:2013-05-01 00:00:00
abstract::In severe status asthmaticus basic medical treatment often fails to improve the patient's condition. Mechanical ventilation in this situation is associated with a high incidence of serious complications. After the bronchodilating effect of moderate-dose magnesium sulfate in asthmatic patients had been demonstrated in ...
journal_title:Intensive care medicine
pub_type: 杂志文章
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journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
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更新日期:2015-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2013-05-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Intensive care medicine
pub_type: 杂志文章,评审
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journal_title:Intensive care medicine
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更新日期:2010-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:1998-06-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:2012-11-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2239-z
更新日期:2004-07-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-018-5423-2
更新日期:2018-11-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:1989-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2007-10-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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journal_title:Intensive care medicine
pub_type: 杂志文章
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journal_title:Intensive care medicine
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journal_title:Intensive care medicine
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-06-01 00:00:00
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更新日期:2015-05-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
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更新日期:2008-04-01 00:00:00
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更新日期:2008-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2001-07-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:1995-07-01 00:00:00