Bartlett R H, Kolobow T, Cooper J D, Richardson P D
Trans Am Soc Artif Intern Organs. 1984;30:679-81.
The potential for lung damage from mechanical ventilation may be much greater than has been realized in the past. Prior studies of extracorporeal support in adults were carried out after patients had been subjected to high airway pressure and hyperventilation for several days. The studies by Gatinoni supported by Kolobow would suggest that earlier application of extracorporeal gas exchange to remove CO2 may be more effective in salvaging the lung, particularly if applied before ventilator-induced lung damage has occurred. These challenging studies, combined with the successful application of extracorporeal support in infants, should stimulate new investigations of extracorporeal support in adult respiratory failure. Extracorporeal support may be a valuable adjunct to lung transplantation if transient pulmonary failure occurs following that operation. However, lung transplantation for acute respiratory failure in a patient who is being supported with ECMO is not recommended. The feasibiilty of an implantable lung has been demonstrated in animals for short periods of time. Continuing studies in this area should be encouraged, particularly before the establishment of a lungless animal preparation to determine some of the nonrespiratory functions of the lung.
机械通气导致肺损伤的可能性可能比过去所认识到的要大得多。以往对成人体外支持的研究是在患者经历数天高气道压力和过度通气之后进行的。由科洛博支持的加蒂诺尼的研究表明，更早应用体外气体交换以清除二氧化碳可能在挽救肺方面更有效，特别是在呼吸机诱发的肺损伤发生之前应用。这些具有挑战性的研究，再加上体外支持在婴儿中的成功应用，应该会激发对成人呼吸衰竭体外支持的新研究。如果肺移植术后发生短暂性肺衰竭，体外支持可能是肺移植的一个有价值的辅助手段。然而，不建议在接受体外膜肺氧合（ECMO）支持的患者中进行急性呼吸衰竭的肺移植。可植入肺在动物身上已被证明在短时间内是可行的。应鼓励在该领域继续开展研究，特别是在建立无肺动物模型以确定肺的一些非呼吸功能之前。
