Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Minerva Anestesiol. 2013 Aug;79(8):934-43. Epub 2013 May 23.
When patients with chronic obstructive lung disease (COPD) and acute on chronic respiratory insufficiency fail non-invasive ventilation (NIV) they are commonly intubated and treated with invasive mechanical ventilation (IMV) to ensure adequate gas exchange. However, IMV itself is associated with considerable complications which can aggravate any pre-existing lung disease and contribute to morbidity and mortality. When lung protective ventilation fails or cannot be maintained, full or partial extracorporeal lung assist (ECLA) is increasingly used to provide oxygenation and/or carbon dioxide removal. This can rescue patients' lives, help resting their lungs until recovery or transplantation or even avoiding intubation and IMV in the first place. Recent technological improvements of extracorporeal devices have made ECLA more efficient and safe. This article discusses different types of ECLA, their potential indications in patients with COPD as well as the preliminary clinical evidence for their effectiveness and safety.
当慢性阻塞性肺疾病（COPD）患者伴发慢性呼吸功能不全急性加重，不能使用无创通气（NIV）时，通常需要气管插管和有创机械通气（IMV）来保证充足的气体交换。然而，IMV 本身也会导致严重的并发症，使原有肺部疾病恶化，导致发病率和死亡率升高。当肺保护性通气失败或无法维持时，常使用体外肺辅助（ECLA）来提供氧合和/或二氧化碳去除。这可以挽救患者生命，帮助其肺部休息，直至恢复或移植，甚至可以避免一开始就进行气管插管和 IMV。体外设备的最新技术改进使 ECLA 更有效且更安全。本文讨论了不同类型的 ECLA，以及它们在 COPD 患者中的潜在适应证，以及它们有效性和安全性的初步临床证据。
