Extracorporeal Gas Exchange for Acute Respiratory Distress Syndrome: Open Questions, Controversies and Future Directions

Membranes

卷:11

Roberto Rona¹  Marco Giani²  Benedetta Fumagalli²  Simone Redaelli²  Antonio Siragusa²  Giuseppe Foti² 

[1] Emergency and Intensive Care, Azienda Socio Sanitaria Territoriale di Monza, 20900 Monza (MB), Italy;

[2] School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;

关键词: acute respiratory distress syndrome;    ARDS;    veno-venous extracorporeal membrane oxygenation;    ECMO;    indications;    prone positioning;   

DOI  :  10.3390/membranes11030172

来源: DOAJ

【 摘 要 】

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) in acute respiratory distress syndrome (ARDS) improves gas exchange and allows lung rest, thus minimizing ventilation-induced lung injury. In the last forty years, a major technological and clinical improvement allowed to dramatically improve the outcome of patients treated with V-V ECMO. However, many aspects of the care of patients on V-V ECMO remain debated. In this review, we will focus on main issues and controversies on caring of ARDS patients on V-V ECMO support. Particularly, the indications to V-V ECMO and the feasibility of a less invasive extracorporeal carbon dioxide removal will be discussed. Moreover, the controversies on management of mechanical ventilation, prone position and sedation will be explored. In conclusion, we will discuss evidences on transfusions and management of anticoagulation, also focusing on patients who undergo simultaneous treatment with ECMO and renal replacement therapy. This review aims to discuss all these clinical aspects with an eye on future directions and perspectives.

【 授权许可】

Unknown