Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina.
Respir Care. 2022 Apr;67(4):480-493. doi: 10.4187/respcare.09288.
Acute respiratory failure with inadequate oxygenation and/or ventilation is a common reason for ICU admission in children and adults. Despite the morbidity and mortality associated with acute respiratory failure, few proven treatment options exist beyond invasive ventilation. Attempts to develop intravascular respiratory assist catheters capable of providing clinically important gas exchange have had limited success. Only one device, the IVOX catheter, was tested in human clinical trials before development was halted without FDA approval. Overcoming the technical challenges associated with providing safe and effective gas exchange within the confines of the intravascular space remains a daunting task for physicians and engineers. It requires a detailed understanding of the fundamentals of gas transport and respiratory physiology to optimize the design for a successful device. This article reviews the potential benefits of such respiratory assist catheters, considerations for device design, previous attempts at intravascular gas exchange, and the motivation for continued development efforts.
急性呼吸衰竭伴氧合和/或通气不足是儿童和成人 ICU 入院的常见原因。尽管急性呼吸衰竭与发病率和死亡率相关，但除了有创通气之外，几乎没有经过证实的治疗方法。开发能够提供临床重要气体交换的血管内呼吸辅助导管的尝试取得的成功有限。只有一种设备，即 IVOX 导管，在开发停止之前，在没有 FDA 批准的情况下，在人体临床试验中进行了测试。在血管内空间内提供安全有效的气体交换方面克服技术挑战仍然是医生和工程师面临的艰巨任务。这需要对气体传输和呼吸生理学的基本原理有详细的了解，以优化设计，从而使设备获得成功。本文回顾了此类呼吸辅助导管的潜在益处、设备设计的注意事项、以前在血管内气体交换方面的尝试，以及继续开发工作的动机。
