Intensive Care Department, University Hospital, Vrije Universiteit Brussels, Brussels, Belgium.
Respir Care. 2020 Apr;65(4):517-524. doi: 10.4187/respcare.07290.
Lung-protective ventilation targeting low tidal volumes and plateau pressures is the mainstay of therapy in patients with ARDS. This ventilation strategy limits pulmonary strain, inflammation, and injury, but it may be associated with profound hypercapnic acidosis. In such conditions, extracorporeal CO removal can attenuate or normalize hypercapnia and may even facilitate ultraprotective ventilation. Almost half of patients with ARDS develop renal failure. Pathophysiological cross-talk between the injured lung and kidney may aggravate global organ failure and weighs negatively on outcomes. A substantial number of patients with ARDS require continuous renal replacement therapy. Systems adapted from conventional renal replacement platforms with blood flows < 500 mL/min can achieve significant CO elimination. Therefore, incorporating low-flow extracorporeal CO removal in a continuous renal replacement therapy circuit is an attractive therapeutic option. We reviewed the relevant literature on combining extracorporeal CO removal with continuous renal replacement therapy.
保护性通气策略以低潮气量和平台压为目标，是急性呼吸窘迫综合征（ARDS）患者治疗的基石。这种通气策略可以限制肺应变、炎症和损伤，但可能与严重的高碳酸血症相关。在这种情况下，体外 CO 去除可以减轻或使高碳酸血症正常化，甚至可以促进超保护性通气。几乎一半的 ARDS 患者会发生肾功能衰竭。受损的肺和肾脏之间的病理生理相互作用可能会加重全身器官衰竭，并对预后产生负面影响。大量 ARDS 患者需要持续肾脏替代治疗。血流<500ml/min 的从传统肾脏替代平台改造而来的系统可以实现显著的 CO 清除。因此，在连续肾脏替代治疗回路中加入低流量体外 CO 去除是一种有吸引力的治疗选择。我们回顾了关于体外 CO 去除与连续肾脏替代治疗相结合的相关文献。
