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Báo cáo khoa học: "Carbon dioxide removal device: how long is long enough"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Carbon dioxide removal device: how long is long enough? | Available online http ccforum.eom content 11 1 405 Letter Carbon dioxide removal device how long is long enough Manuel E Cevallos and Joseph B Zwischenberger Cardiothoracic Surgery Department. The University of Texas Medical Branch 301 University Boulevard Galveston Texas 77555-0828 USA Correspondence Manuel Cevallos mecevall@utmb.edu Published 29 January 2007 This article is online at http ccforum.com content 11 1 405 2007 BioMed Central Ltd Critical Care 2007 11 405 doi 10.1186 cc5130 See related research by Livigni et al. http ccforum.com content 10 6 R151 Livigni and coworkers 1 reported on the safety and efficacy of a venovenous carbon dioxide removal VVCO2R circuit in a short-term study to 12 hours conducted in healthy sheep. During extracorporeal carbon dioxide removal carbon dioxide is transferred across a gas exchanger whereas oxygen diffuses across the native lungs. In 1969 Kolobow and coworkers 2 described use of VVCO2R in healthy sheep for 1 week and they later demonstrated improved survival in injured sheep 3 . Clinical trials however failed to show improved outcomes 4 . Arteriovenous carbon dioxide removal AVCO2R as a simple arteriovenous shunt eliminates several circuit components. AVCO2R removes near total carbon dioxide production with only 1 l min approximately 15 of cardiac output blood flow and appears to be effective in acute respiratory distress disorder ARDS as shown in prospective randomized large animal and preliminary clinical trials. Our sheep model of severe ARDS is based on a third degree burn to 40 of the total body surface area and 48-breath smoke inhalation injury 5 . Because the median duration of AVCO2R treatment for ARDS is 4.8 days our model allows comparison of ventilatory techniques over 5 days to evaluate pathophysiology and outcomes 6 . Based on the experience with carbon dioxide removal two major concerns arise. First the circuit blood flow employed by Livigni and coworkers is only 5 of the cardiac output which was .