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Extracorporeal Strategies in Acute Respiratory Distress Syndrome.
Semin Respir Crit Care Med. 2019 02; 40(1):114-128.SR

Abstract

Despite the breadth of life-sustaining interventions available, mortality in patients with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation of the potential iatrogenic injury associated with the use of mechanical ventilation has led clinicians and researchers to seek alternatives. Extracorporeal life support (ECLS) may be used to rescue patients with severely impaired gas exchange and provide time for injured lungs to recover while treating the underlying disease. In patients with ARDS, venovenous (VV) ECLS is commonly used, where venous blood is drained into a circuit that passes through a membrane lung, which provides gas exchange, and then returned to the venous system. VV-ECLS can be configured as a system that uses higher blood flows with extracorporeal membrane oxygenation (VV-ECMO) or as one that uses lower blood flows for extracorporeal carbon dioxide removal (VV-ECCO2R). Recent studies support the use of VV-ECMO in patients with severe ARDS who present with refractory gas exchange despite the use of lung-protective mechanical ventilation, positive end-expiratory pressure optimization, neuromuscular blockade, and prone positioning. The optimal management of patients during ECLS (i.e., anticoagulation, transfusions, mechanical ventilation) and the role of ECCO2R in the management of ARDS remain to be determined.

Authors+Show Affiliations

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada.Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

31060093

Citation

Cavayas, Yiorgos Alexandros, et al. "Extracorporeal Strategies in Acute Respiratory Distress Syndrome." Seminars in Respiratory and Critical Care Medicine, vol. 40, no. 1, 2019, pp. 114-128.
Cavayas YA, Thakore A, Fan E. Extracorporeal Strategies in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019;40(1):114-128.
Cavayas, Y. A., Thakore, A., & Fan, E. (2019). Extracorporeal Strategies in Acute Respiratory Distress Syndrome. Seminars in Respiratory and Critical Care Medicine, 40(1), 114-128. https://doi.org/10.1055/s-0039-1685191
Cavayas YA, Thakore A, Fan E. Extracorporeal Strategies in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019;40(1):114-128. PubMed PMID: 31060093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal Strategies in Acute Respiratory Distress Syndrome. AU - Cavayas,Yiorgos Alexandros, AU - Thakore,Aneesh, AU - Fan,Eddy, Y1 - 2019/05/06/ PY - 2019/5/7/entrez PY - 2019/5/7/pubmed PY - 2020/4/22/medline SP - 114 EP - 128 JF - Seminars in respiratory and critical care medicine JO - Semin Respir Crit Care Med VL - 40 IS - 1 N2 - Despite the breadth of life-sustaining interventions available, mortality in patients with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation of the potential iatrogenic injury associated with the use of mechanical ventilation has led clinicians and researchers to seek alternatives. Extracorporeal life support (ECLS) may be used to rescue patients with severely impaired gas exchange and provide time for injured lungs to recover while treating the underlying disease. In patients with ARDS, venovenous (VV) ECLS is commonly used, where venous blood is drained into a circuit that passes through a membrane lung, which provides gas exchange, and then returned to the venous system. VV-ECLS can be configured as a system that uses higher blood flows with extracorporeal membrane oxygenation (VV-ECMO) or as one that uses lower blood flows for extracorporeal carbon dioxide removal (VV-ECCO2R). Recent studies support the use of VV-ECMO in patients with severe ARDS who present with refractory gas exchange despite the use of lung-protective mechanical ventilation, positive end-expiratory pressure optimization, neuromuscular blockade, and prone positioning. The optimal management of patients during ECLS (i.e., anticoagulation, transfusions, mechanical ventilation) and the role of ECCO2R in the management of ARDS remain to be determined. SN - 1098-9048 UR - https://www.unboundmedicine.com/medline/citation/31060093/Extracorporeal_Strategies_in_Acute_Respiratory_Distress_Syndrome_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0039-1685191 DB - PRIME DP - Unbound Medicine ER -