Oxygen delivery and carbon dioxide removal on venovenous extracorporeal membrane oxygenation.

IF 3.4 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-01-29 DOI:10.1097/MCC.0000000000001259

David Furfaro, Alexander Supady, Darryl Abrams

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引用次数: 0

Abstract

Purpose of review: Venovenous extracorporeal membrane oxygenation (VV-ECMO) provides gas exchange for patients with advanced respiratory failure who cannot maintain adequate oxygenation or carbon dioxide (CO 2 ) clearance through conventional mechanical ventilation. This review examines clinical applications of VV-ECMO with a focus on optimizing oxygen delivery and CO 2 removal.

Recent findings: Over the past two decades, VV-ECMO utilization has expanded, now serving as a bridge to recovery in cases of severe hypoxemic and hypercapnic respiratory failure, as procedural support, and as a bridge to lung transplantation. Recent data have corroborated the role of VV-ECMO in managing acute respiratory distress syndrome (ARDS), and guidelines from the American Thoracic Society (ATS) and the European Society of Intensive Care Medicine (ESICM) now recommend it be considered for severe ARDS.

Summary: This review aims to provide insights into the evolving role of VV-ECMO in the management of critical respiratory failure. Key determinants of oxygenation are discussed, particularly optimizing the ratio of VV-ECMO blood flow to cardiac output (CO). We analyze factors influencing CO 2 clearance and review available VV-ECMO configurations and their effects on gas exchange. We discuss practical targets for oxygenation and CO 2 removal in VV-ECMO, along with adjunctive techniques for refractory hypoxemia and hypercapnia.

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静脉-静脉体外膜氧合的氧气输送和二氧化碳去除。

回顾目的：静脉-静脉体外膜氧合（VV-ECMO）为不能通过常规机械通气维持足够氧合或二氧化碳（CO2）清除的晚期呼吸衰竭患者提供气体交换。本文综述了VV-ECMO的临床应用，重点是优化氧输送和CO2去除。最近发现：在过去的二十年中，VV-ECMO的应用已经扩大，现在作为严重低氧血症和高碳酸血症呼吸衰竭病例恢复的桥梁，作为程序支持，并作为肺移植的桥梁。最近的数据证实了VV-ECMO在治疗急性呼吸窘迫综合征（ARDS）中的作用，美国胸科学会（ATS）和欧洲重症监护医学学会（ESICM）的指南现在建议考虑使用VV-ECMO治疗严重的ARDS。摘要：本综述旨在深入了解VV-ECMO在重症呼吸衰竭治疗中的作用。讨论了氧合的关键决定因素，特别是优化VV-ECMO血流量与心输出量（CO）的比例。我们分析了影响CO2清除的因素，并回顾了可用的VV-ECMO配置及其对气体交换的影响。我们讨论了VV-ECMO中氧合和CO2去除的实际目标，以及难治性低氧血症和高碳酸血症的辅助技术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.