title: Extracorporeal carbon dioxide removal: the future of lung support lies in the history.
abstract: Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field.
authors.affiliation: International Renal Research Institute, Vicenza, Italy.
authors.forename: Manish
authors.initials: M
authors.lastname: Kaushik
authors.forename: Marzena
authors.initials: M
authors.lastname: Wojewodzka-Zelezniakowicz
authors.forename: Dinna N
authors.initials: DN
authors.lastname: Cruz
authors.forename: A
authors.initials: A
authors.lastname: Ferrer-Nadal
authors.forename: Catarina
authors.initials: C
authors.lastname: Teixeira
authors.forename: Elena
authors.initials: E
authors.lastname: Iglesias
authors.forename: Jeong Chul
authors.initials: JC
authors.lastname: Kim
authors.forename: Antonio
authors.initials: A
authors.lastname: Braschi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Piccinni
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D002245:Carbon Dioxide / Q000097:blood* / Q000302:isolation & purification*; D057785:Catheters; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000266:history / Q000295:instrumentation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000266:history / Q000295:instrumentation / Q000379:methods; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008168:Lung / Q000473:pathology; D012131:Respiratory Insufficiency / Q000628:therapy
chemical_list: D002245:Carbon Dioxide