title: Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction.
abstract: In modern intensive care medicine, lungs and kidneys frequently are involved in the context of multiorgan failure. When organ dysfunction occurs, the primary clinical management of critically ill patients is based on support/replacement of organ function until recovery. Mechanical ventilation is the first-line intervention in case of respiratory failure, but in most severe cases may, itself, cause ventilator-induced lung injury. The same inflammatory mechanism also may harm the kidney through mediator spillover from the injured lungs into the bloodstream. To limit the deleterious effects of mechanical ventilation and avoid excessive carbon dioxide accumulation, devices for extracorporeal CO2 removal (ECCO2R), have been developed. Some consistent clinical experience currently has been reached in patients with obstructive pulmonary disease and acute respiratory distress syndrome. Interestingly, ECCO2R recently has been coupled with continuous renal replacement therapy systems into specific lung-renal support. The results from the first experimental and clinical applications are encouraging: it is expected that a system including continuous renal replacement therapy and ECCO2R will develop from the current pioneering attempts into a feasible multiple-organ support platform to become commonly used as a routine tool in intensive care units. This review focuses on recent literature and clinical applications of renal-pulmonary support with specific attention to technical aspects of the most recent materials and devices.
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy. Electronic address: zaccaria.ricci@gmail.com.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy; International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*
keywords: CRRT; ECCO(2)R; MOF; Multiorgan failure; continuous renal replacement therapy; extracorporeal CO(2) removal; extracorporeal membrane oxygenation