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      Physiological and Technical Considerations of Extracorporeal CO 2 Removal

      review-article
      1 , , 2 , 3
      Critical Care
      BioMed Central

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          Abstract

          This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

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          Most cited references27

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          A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.

          Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients. This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean. The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization. This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure.
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            Estimation of shear stress-related blood damage in heart valve prostheses--in vitro comparison of 25 aortic valves.

            The hemodynamics of heart valve prostheses can be reproducibly investigated in vitro within circulatory mock loops. By measuring the downstream velocity and shear stress fields the shear stresses which are clinically responsible for damage to platelets and red blood cells can be determined. The mechanisms of damage and the effects of shear stresses on blood corpuscles were investigated by Wurzinger et al. at the Aerodynamics Institute of the RWTH Aachen. In the present study, the above data are incorporated into a mathematical correlation, which serves as a basic model for the estimation of blood damage. This mathematical model was applied to in vitro investigations of 25 different aortic valve prostheses. The results were compared to clinical findings. In most cases agreement was good, indicating that this model may be directly applied to the clinical situation. This new method facilitates the estimation of clinically expected blood damage from in vitro measurements. It may be useful for the development and evaluation of new valve prostheses. By comparative evaluation of different valve types it also provides additional information to help the implanting surgeon select the optimum valve for his patient.
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              Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control.

              To assess efficacy and safety of noninvasive ventilation-plus-extracorporeal Co2 removal in comparison to noninvasive ventilation-only to prevent endotracheal intubation patients with acute hypercapnic respiratory failure at risk of failing noninvasive ventilation.
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                Author and article information

                Contributors
                Christian.Karagiannidis@uni-wh.de
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                9 March 2019
                9 March 2019
                2019
                : 23
                : 75
                Affiliations
                [1 ]ISNI 0000 0000 8852 305X, GRID grid.411097.a, Department of Pneumology and Critical Care Medicine, , Cologne-Merheim Hospital, ARDS and ECMO Centre, Witten/Herdecke University Hospital, ; Ostmerheimer Strasse 200, D-51109 Cologne, Germany
                [2 ]ISNI 0000 0001 0728 696X, GRID grid.1957.a, Department of Cardiovascular Engineering, , Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, ; Aachen, Germany
                [3 ]ISNI 0000 0001 0661 1177, GRID grid.417184.f, Interdepartmental Division of Critical Care Medicine, , University of Toronto and the Extracorporeal Life Support Program, Toronto General Hospital, ; Toronto, Canada
                Article
                2367
                10.1186/s13054-019-2367-z
                6408850
                30849995
                634f4380-c7a1-4428-ab2f-2d7d9ae1ec12
                © Karagiannidis et al. 2019
                History
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                Review
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                © The Author(s) 2019

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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