tailieunhanh - Báo cáo y học: "Extracorporeal gas exchange in acute lung injury: step by step towards expanded indications"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Extracorporeal gas exchange in acute lung injury: step by step towards expanded indications? | Dembinski and Kuhlen Critical Care 2010 14 116 http content 14 1 116 CRITICAL CARE COMMENTARY L__ Extracorporeal gas exchange in acute lung injury step by step towards expanded indications Rolf Dembinski 1 and Ralf Kuhlen2 See related research by Mueller etal. http content 13 6 R205 Abstract Extracorporeal membrane oxygenation ECMO is widely accepted as a rescue therapy in patients with acute life-threatening hypoxemia in the course of severe acute respiratory distress syndrome ARDS . However possible side effects and complications are considered to limit beneficial outcome effects. Therefore widening indications with the aim of reducing ventilator induced lung injury VILI is still controversial. Consequently technological progress is an important strategy. Miniaturized ECMO systems are believed to simplify handling and reduce side effects and complications. Mueller and co-workers evaluated such a small-sized device in 60 patients with severe ARDS. They accomplished both the treatment of severe hypoxemia and reduction of VILI demonstrating feasibility a moderate rate of severe complications and a 45 intensive care survival rate. Although neither randomized nor controlled this study should encourage others to implement such systems in clinical practice. From a strategic perspective this is another small but useful step towards implementing extracorporeal gas exchange for the prevention of VILI. It is already common sense that the prevention of acute life-threatening hypoxemia usually outweighs the risks of this technique. The next step should be to prove that prevention of life-threatening VILI balances the risks too. In the previous issue of Critical Care Thomas Mueller and co-workers 1 presented their experience with a miniaturized veno-venous extracorporeal membrane oxygenation ECMO system in 60 consecutive patients Correspondence rdembinski@ department of Intensive Care Medicine University Hospital RWTH Aachen .