Thoracic transplantationLungThe Use of CO2 Removal Devices in Patients Awaiting Lung Transplantation: An Initial Experience
Section snippets
Materials and Methods
From November 2005 to September 2009, 12 LT waiting list patients (7 males, 5 females) of overall mean age of 43.3 ± 15.5 years were treated with extracorporeal devices for CO2 removal because of severe ventilation-refractory hypercapnia with respiratory acidosis. In 6 patients, the Decap system was used; the other 6 underwent ILA implantation. The decision on which device was made on the basis of the hemodynamic capability of the patient to sustain extracorporeal gas exchange with or without
Results
All patients except 1 were on mechanical ventilatory support before device implantation. The indication for decapneization device implantation was severe hypercapnia and acidosis refractory to positive high pressure mechanical ventilation. The only subject not on a ventilator was a lung transplant patient treated with ILA because of respiratory failure owing to worsening chronic rejection. This not intubated patient has been on ILA assistance awaiting lung retransplantation. The original lung
Discussion
The aim of insertion of percutaneous extracorporeal lung assistance devices is to allow lung protective ventilation, to improve gas exchange, and at the same time, to reduce the lung damage due to high-pressure–high-volume mechanical ventilation. In this way, native lung function is supported, the diseased lung may better and more quickly recover from acute respiratory failure as artificial ventilation can be downgraded. Our results confirmed the decapneization efficacy of ILA and Decap at 24,
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2016, Journal of Heart and Lung TransplantationCitation Excerpt :Finally, from a practical standpoint, it is important to note that because pump-less A-V ECMO is typically cannulated through the femoral vessels, it is most commonly a non-ambulatory strategy. V-V ECCO2R is another promising right-sided approach to LT bridging in patients presenting with predominant impairment in CO2 elimination.80,81 Because CO2 has high blood solubility and is carried as bicarbonate in small blood volumes, blood flow requirements for CO2 removal are far lower than for provision of O2 supply.
CASE 7—2016 Choice of Percutaneous Mechanical Assistance During Cardiopulmonary Instability: Heart, Lungs, or Both?
2016, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Advantages of the single-site approach include avoidance of the femoral access site, improved patient mobility, and considerably reduced recirculation when the cannula is positioned properly. Also known as the “artificial lung” or pumpless extracorporeal lung assist (pECLA; Interventional Lung Assist, Novalung, Heilbronn, Germany),16–18 it is used in patients with acute lung injury yet stable hemodynamically. Typically, inflow is femoral artery, and outflow is femoral vein.
ICU Care Before and After Lung Transplantation
2016, ChestCitation Excerpt :CO2 removal in hypercapnic emphysema patients is used to avoid intubation. More than 60% of COPD patients could be weaned from these devices demonstrating rather a “bridge to recovery” approach in this subgroup.53-55 Patients with acute respiratory failure (eg, ARDS, pneumonia) are generally not considered as suitable candidates for LTx.