Ospedale San Gerardo, Monza, Italy.
Crit Care Med. 2010 Oct;38(10 Suppl):S549-54. doi: 10.1097/CCM.0b013e3181f1fe0c.
Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventilatory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to hemodialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.
通过体外二氧化碳清除来降低患者的通气需求，可以避免机械通气和呼吸机相关性肺损伤。本文阐述了急性呼吸窘迫综合征患者通气需求增加的原因，以及持续损伤的一些机制。体外气体交换主要被用作严重低氧血症患者的抢救手段。尽管这一适应证仍然成立，但我们建议体外二氧化碳清除可以控制患者的通气需求，允许维持自主呼吸，同时避免插管和减少同时的镇静需求。本文描绘了一种情况，即高效的二氧化碳清除装置可以维持患者的血气平衡，其侵入性与血液透析相当。通过血液滤过和可代谢酸负荷的组合可以实现高的二氧化碳清除效率。
