Annals of the American Thoracic Society
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The use of extracorporeal membrane oxygenation to support patients with cardiac and respiratory failure has increased substantially in the last decade. Although the evidence base for its use in adults with respiratory failure is growing, many questions remain to be answered. Ongoing research is aimed at clarifying the role of extracorporeal membrane oxygenation, as well as extracorporeal carbon dioxide removal, in various forms of hypoxemic and hypercapnic respiratory failure, and at defining the optimal techniques for its use. This, of course, is a moving target, as advances in the technology of extracorporeal membrane oxygenation, and the potential development of a true artificial lung, continue at a brisk pace.
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This article assesses developments in cardiorespiratory medicine since the Nobel Prize in Physiology or Medicine was awarded in 1956 for advancements in the study of cardiorespiratory disease. In chronic obstructive pulmonary disease, advances were accelerated by the discovery of a genetically determined cause for pulmonary emphysema in the genetic abnormality alpha-1 antitrypsin deficiency. This causes a deficiency of the inhibitor of neutrophil elastase, which results in increased degradation of lung elastin and the development of pulmonary emphysema. ⋯ This insight indicates the potential of agents that prevent lung elastin degradation. Such an agent is hyaluronan aerosol, which is deficient in post mortem lungs with chronic obstructive pulmonary disease and has been shown to block elastin degradation, possibly by a barrier function. Thus it would appear that hyaluronan could have therapeutic potential in chronic obstructive pulmonary disease.
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The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery is highly variable. ⋯ PCplanner represents an acceptable, usable, and clinically promising systems-based approach to delivering EHR-triggered, needs-targeted ICU-based palliative care within a standard clinical workflow. A clinical trial in a larger population is needed to evaluate its efficacy.