title: Role and potentials of low-flow CO(2) removal system in mechanical ventilation.
abstract: OBJECTIVE
  An analysis of the technological implementation of extracorporeal CO(2) removal (ECCO(2)R) techniques and of its clinical application. A new classification of ECCO(2)R, based on technological aspects, clinical properties and physiological performance, is proposed.
  
  
  RESULTS
  The use of a ventilation with lower tidal volumes has been proved successful in acute respiratory distress syndrome (ARDS) patients but can be extremely problematic, especially when dealing with respiratory acidosis. The implementation of ECCO(2)R devices can represent the missing link between the prevention of ventilator-induced lung injury and pH control. ECCO(2)R has attracted increasing interest because of new less-invasive approaches allowing an easier management of ARDS patients. Recent studies have also shown that ECCO(2)R can also be used in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and as a bridge to lung transplantation.
  
  
  CONCLUSIONS
  The future ventilatory management of patients with acute respiratory failure may include a minimally invasive extracorporeal carbon dioxide removal circuit associated with the least amount of ventilatory support (noninvasive in COPD and/or invasive in ARDS) to minimize sedation, prevent ventilator-induced acute lung injury and nosocomial infections. Randomized clinical trials in the pipeline will confirm this fascinating hypothesis.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, S.Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Terragni
authors.forename: Giorgia
authors.initials: G
authors.lastname: Maiolo
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000097:blood*; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*
chemical_list: D002245:Carbon Dioxide