Crit Care Resusc
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Observational Study
The impact of venovenous extracorporeal membrane oxygenation on cytokine levels in patients with severe acute respiratory distress syndrome: a prospective, observational study.
The immunoinflammatory response is central to the pathogenesis of acute respiratory distress syndrome (ARDS). However, little is known how this is affected by venovenous (VV) extracorporeal membrane oxygenation (ECMO). Our objective was to investigate the factors that influence the inflammatory response of patients with ARDS undergoing VV ECMO, and to analyse the impact of this response on hospital mortality. ⋯ Cytokine levels, on average, fall rapidly after initiation of VV ECMO, which may be related to the reduction of invasiveness of mechanical ventilation. Higher cytokine levels are associated with extrapulmonary causes of ARDS, more aggressive mechanical ventilation before VV ECMO, and mortality.
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Extracorporeal venovenous carbon dioxide removal (ECCO2R) is increasingly used to facilitate ultraprotective mechanical ventilation, or to prevent or avoid mechanical ventilation in selected patients. This review focuses on how extracorporeal devices clear CO2, their impact on native pulmonary physiology, and systemic gas exchange. Finally, we discuss the modifications to patient management required while on ECCO2R.
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Significant interactions between drugs, extracorporeal membrane oxygenation (ECMO) circuits and critical illness may affect the pharmacokinetic properties of antibiotics in critically ill patients receiving ECMO. ⋯ We provide preliminary evidence that ciprofloxacin dosing in ECMO patients should remain in line with the recommended dosing strategies for critically ill patients not receiving ECMO.
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Over the past decade, there has been growing interest in extracorporeal membrane oxygenation (ECMO) as a rescue therapy for patients with severe acute respiratory distress syndrome (ARDS) and cardiogenic shock. Although survival of ECMO-treated patients has improved recently, the incidence of ECMO-related complications such as bleeding and nosocomial infections remains unacceptably high. In addition, patients often experience long-term physiological and psychological sequelae. ⋯ Because the technique exposes patients to complications and is associated with high costs and resource utilisation, prediction models have been developed to assist clinicians in identifying patients that would most likely survive after ECMO treatment. In addition, these prediction models enable comparison of risk-adjusted outcomes, both over time and between centres. Our review explores the latest predictive survival models developed for ECMO-treated severe cardiogenic shock and ARDS patients.