title: Carbon dioxide dialysis will save the lung.
abstract: Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventilatory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to hemodialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.
authors.affiliation: Ospedale San Gerardo, Monza, Italy. antonio.pesenti@unimib.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D008168:Lung / Q000503:physiopathology; D011650:Pulmonary Alveoli / Q000503:physiopathology; D006435:Renal Dialysis / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012126:Respiratory Dead Space / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D055397:Ventilator-Induced Lung Injury / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D002245:Carbon Dioxide