Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France.
Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 47, boulevard de l'Hôpital, 75013, Paris, France.
Intensive Care Med. 2022 Oct;48(10):1308-1321. doi: 10.1007/s00134-022-06796-w. Epub 2022 Aug 9.
Extracorporeal carbon dioxide removal (ECCOR) is a form of extracorporeal life support (ECLS) largely aimed at removing carbon dioxide in patients with acute hypoxemic or acute hypercapnic respiratory failure, so as to minimize respiratory acidosis, allowing more lung protective ventilatory settings which should decrease ventilator-induced lung injury. ECCOR is increasingly being used despite the lack of high-quality evidence, while complications associated with the technique remain an issue of concern. This review explains the physiological basis underlying the use of ECCOR, reviews the evidence regarding indications and contraindications, patient management and complications, and addresses organizational and ethical considerations. The indications and the risk-to-benefit ratio of this technique should now be carefully evaluated using structured national or international registries and large randomized trials.
体外二氧化碳去除（ECCOR）是一种体外生命支持（ECLS）形式，主要旨在去除急性低氧或急性高碳酸血症性呼吸衰竭患者的二氧化碳，从而最大限度地减少呼吸性酸中毒，允许采用更多的肺保护性通气设置，这应该会减少呼吸机相关性肺损伤。尽管缺乏高质量的证据，但 ECCOR 的应用越来越多，而与该技术相关的并发症仍然是一个令人关注的问题。本综述解释了使用 ECCOR 的生理学基础，回顾了关于适应证和禁忌证、患者管理和并发症的证据，并讨论了组织和伦理方面的考虑。现在应该使用结构化的国家或国际登记处和大型随机试验来仔细评估该技术的适应证和风险效益比。
