ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Biography Historical Article
"Treating Lungs": The Scientific Contributions of Dr. Theodor Kolobow.
We are fortunate to live in an age in which biomedical technology has provided us with unprecedented ability to supplant the functions of organs and support the physiologic processes of the human body. Ingenious doctors, physiologists, and engineers helped create these advances with new and innovative ideas. One of these pioneers was Dr. ⋯ In retrospect, much of Kolobow's work was unified by the theme of preventing iatrogenic lung injury caused by mechanical ventilation. This tenet became more obvious as his later studies progressed to developing techniques and devices intended to limit ventilator pressures, and prevent bacterial colonization of the lungs. Although he formally retired from his research endeavors in 2009, the impact of his contributions remains prominent in our everyday use of techniques and equipment that he either originated or helped to develop.
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Cardiopulmonary failure because of drowning with accidental hypothermia (AH) remains a major task for emergency care physicians. In this case series, we describe our experience in nine patients with cardiopulmonary failure after drowning with AH less than 35°C, who were provided on an emergency basis with extracorporeal life support (ECLS) system or extracorporeal membrane oxygenation (ECMO). Conservative rewarming methods are not considered for this study. ⋯ Cause of death was severe neurologic damage in six patients and cardiac failure in one patient. The use of ECLS/ECMO is a therapy option for a small range of patients with cardiopulmonary failure because of drowning with AH. Nevertheless, the interval of preclinical rescue remains extensively long.
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We previously described a highly efficient extracorporeal CO2 removal technique called respiratory electrodialysis (R-ED). Respiratory electrodialysis was composed of a hemodiafilter and a membrane lung (ML) positioned along the extracorporeal blood circuit, and an electrodialysis (ED) cell positioned on the hemodiafiltrate. The ED regionally increased blood chloride concentration to convert bicarbonate to CO2 upstream the ML, thus enhancing ML CO2 extraction (VCO2ML). ⋯ Subsequently, VCO2ML increased from 27 ± 1.7 to 91.3 ± 1.5 ml/min (0 vs. 8 A, p < 0.001). Respiratory electrodialysis is efficient in increasing VCO2ML of an extracorporeal circuit featuring an ML perfused by hemodiafiltrate. During R-ED, the VCO2ML can be significantly enhanced by increasing the ED current.
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Case Reports
Prolonged Maintenance of VV ECMO for 104 Days with Native Lung Recovery in Acute Respiratory Failure.
Recently, extracorporeal membrane oxygenation (ECMO) support has been increasingly applied in acute respiratory failure. The ECMO brings some advantages for enhancing the capacity of lung regeneration. Thus, the timing of determining irreversibility of the injured lung could be delayed. ⋯ In this case, the initial empirical treatment showed no response within 4 weeks with ECMO support but the patient did not want a lung transplantation. With prolonged maintenance of the ECMO, related ethical issues arose, such as how long should the applied ECMO be maintained. Hence, there was a discussion that was centered on the timing of determining futility and ethical issues, while applying the ECMO in acute respiratory failure.