Extracorporeal support to achieve lung-protective and diaphragm-protective ventilation.
Journal
Current opinion in critical care
ISSN: 1531-7072
Titre abrégé: Curr Opin Crit Care
Pays: United States
ID NLM: 9504454
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
entrez:
27
12
2019
pubmed:
27
12
2019
medline:
1
12
2020
Statut:
ppublish
Résumé
Extracorporeal support allows ultraprotective controlled and assisted ventilation, which can prevent lung and diaphragm injury. We focused on most recent findings in the application of extracorporeal support to achieve lung protection and diaphragm- protection, as well as on relevant monitoring. A recent randomized trial comparing the efficacy of extracorporeal support as a rescue therapy to conventional protective mechanical ventilation was stopped for futility but post hoc analyses suggested that extracorporeal support is beneficial for patients with very severe acute respiratory distress syndrome. However, the optimal ventilation settings during extracorporeal support are still debated. It is conceivable that they should enable the highest amount of CO2 removal with lowest mechanical power.Extracorporeal CO2 removal can minimize acidosis and enable the use of ultra-protective lung ventilation strategies when hypoxemia is not a major issue. Moreover, it can protect lung and diaphragm function during assisted ventilation through control of the respiratory effort.Lung mechanics, gas exchange, diaphragm electrical activity, ultrasound, electrical impedance tomography could be integrated into clinical management to define lung and diaphragm protection and guide personalized ventilation settings. Technological improvement and the latest evidence indicate that extracorporeal support may be an effective tool for lung and diaphragm protection.
Identifiants
pubmed: 31876625
doi: 10.1097/MCC.0000000000000686
pii: 00075198-202002000-00012
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
66-72Références
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