title: Extracorporeal CO2 removal--a way to achieve ultraprotective mechanical ventilation and lung support: the missing piece of multiple organ support therapy.
abstract: Extracorporeal therapies are able to sustain life through different mechanisms. This approach, called multiple organ support therapy, can in fact obtain blood purification by hemodialysis/hemofiltration to replace kidney function, temperature control, electrolyte and acid-base control to mimic homeostatic regulation of the kidney and circulation, fluid balance control to support the right hydration and cardiac performance, cardiac support removing cardiodepressant substances and equilibrating potassium levels, blood detoxification and liver support by coupled plasma filtration and adsorption or direct adsorption on blood (hemoperfusion), immunomodulation and endothelial support in the presence of sepsis by cutting the peaks of pro- and anti-inflammatory mediators, and immunoadsorption or adsorption of specific substances such as endotoxin. A missing piece of this group of therapies was the protective lung support. Today this is made possible by removal of CO(2) either by complete extracorporeal membrane oxygenation or by using decapneization in conjunction with hemofiltration in a system called DECAP/DECAPSMART. In conclusion, circulating blood outside the body and treating it with different filters or cartridges in a multiple organ support therapy may represent an important support for multiple organ dysfunction conditions induced by sepsis, acute respiratory distress syndrome and in recent times by complicated H1N1-related infections.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gramaticopolo
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chronopoulos
authors.forename: Pasquale
authors.initials: P
authors.lastname: Piccinni
authors.forename: Federico
authors.initials: F
authors.lastname: Nalesso
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brendolan
authors.forename: Monica
authors.initials: M
authors.lastname: Zanella
authors.forename: Dinna N
authors.initials: DN
authors.lastname: Cruz
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D002245:Carbon Dioxide / Q000302:isolation & purification*; D016638:Critical Illness / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006440:Hemofiltration / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D055103:Hypodermoclysis / Q000379:methods; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000517:prevention & control; D008168:Lung / Q000503:physiopathology*; D009102:Multiple Organ Failure / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy
chemical_list: D002245:Carbon Dioxide