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Wang XX, Guo Y. [Recent research on extracorporeal carbon dioxide removal]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:205-209. [PMID: 36854699 DOI: 10.7499/j.issn.1008-8830.2208187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Extracorporeal carbon dioxide removal is an artificial lung auxiliary technique based on extrapulmonary gas exchange and can effectively remove carbon dioxide and provide oxygenation to a certain extent, and it is one of the effective treatment techniques for hypercapnia developed after mechanical ventilation and extracorporeal membrane oxygenation in recent years and has wide application prospect. This article elaborates on the development, working principle, advantages, classification, complications, and clinical application of extracorporeal carbon dioxide removal, so as to provide a new choice for extracorporeal carbon dioxide removal in clinical practice.
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Affiliation(s)
- Xiao-Xin Wang
- Neonatal Medical Center, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yan Guo
- Neonatal Medical Center, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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Lin S, Li X, Xie B, Yue W, Yao X, Lin M. Ipratropium bromide and noninvasive ventilation treatment for COPD. Am J Transl Res 2022; 14:3319-3326. [PMID: 35702113 PMCID: PMC9185084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/09/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the effects of ipratropium bromide combined with non-invasive ventilation for patients with both chronic obstructive pulmonary disease (COPD) and respiratory failure. METHODS A total of 110 patients with both COPD and respiratory failure who were admitted to our hospital from April 2018 to August 2019 were enrolled in this study; of which 52 patients were treated with a noninvasive ventilator as Group A, and the rest were treated with ipratropium bromide combined with noninvasive ventilation as Group B. The two groups were compared for blood gas indexes, pulmonary function, and treatment efficacy, and adverse reactions. RESULTS After treatment, Group B showed better blood gas indexes and pulmonary function than Group A (both P < 0.05), and Group B also showed significantly lower levels of inflammatory factors than Group A (P < 0.05). In addition, the efficacy and life quality of Group B were better than those of Group A, and adverse reactions of Group B were less than those of Group A (all P < 0.05). CONCLUSION Ipratropium bromide combined with noninvasive ventilation is effective in the treatment of patients with both COPD and respiratory failure.
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Affiliation(s)
- Sheng Lin
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
| | - Xiaoqin Li
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
| | - Wenxiang Yue
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
| | - Xiujuan Yao
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
| | - Ming Lin
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University Fuzhou 350001, Fujian Provincial, China
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Barrett NA, Hart N, Daly KJR, Marotti M, Kostakou E, Carlin C, Lua S, Singh S, Bentley A, Douiri A, Camporota L. A randomised controlled trial of non-invasive ventilation compared with extracorporeal carbon dioxide removal for acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Ann Intensive Care 2022; 12:36. [PMID: 35445986 PMCID: PMC9021560 DOI: 10.1186/s13613-022-01006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients presenting with acute hypercapnic respiratory failure due to exacerbations of chronic obstructive pulmonary disease (AECOPD) are typically managed with non-invasive ventilation (NIV). The impact of low-flow extracorporeal carbon dioxide removal (ECCO2R) on outcome in these patients has not been explored in randomised trials. Methods Open-label randomised trial comparing NIV (NIV arm) with ECCO2R (ECCO2R arm) in patients with AECOPD at high risk of NIV failure (pH < 7.30 after ≥ 1 h of NIV). The primary endpoint was time to cessation of NIV. Secondary outcomes included device tolerance and complications, changes in arterial blood gases, hospital survival. Results Eighteen patients (median age 67.5, IQR (61.5–71) years; median GOLD stage 3 were enrolled (nine in each arm). Time to NIV discontinuation was shorter with ECCO2R (7:00 (6:18–8:30) vs 24:30 (18:15–49:45) h, p = 0.004). Arterial pH was higher with ECCO2R at 4 h post-randomisation (7.35 (7.31–7.37) vs 7.25 (7.21–7.26), p < 0.001). Partial pressure of arterial CO2 (PaCO2) was significantly lower with ECCO2R at 4 h (6.8 (6.2–7.15) vs 8.3 (7.74–9.3) kPa; p = 0.024). Dyspnoea and comfort both rapidly improved with commencement of ECCO2R. There were no severe or life-threatening complications in the study population. There were no episodes of major bleeding or red blood cell transfusion in either group. ICU and hospital length of stay were longer with ECCO2R, and there was no difference in 90-day mortality or functional outcomes at follow-up. Interpretation There is evidence of benefit associated with ECCO2R with time to improvement in respiratory acidosis, in respiratory physiology and an immediate improvement in patient comfort and dyspnoea with commencement of ECCO2R. In addition, there was minimal clinically significant adverse events associated with ECCO2R use in patients with AECOPD at risk of failing or not tolerating NIV. However, the ICU and hospital lengths of stay were longer in the ECCO2R for similar outcomes. Trial registration The trial is prospectively registered on ClinicalTrials.gov: NCT02086084. Registered on 13th March 2014, https://clinicaltrials.gov/ct2/show/NCT02086084?cond=ecco2r&draw=2&rank=8 Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01006-8.
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Affiliation(s)
- Nicholas A Barrett
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK. .,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.
| | - Nicholas Hart
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.,Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Kathleen J R Daly
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Martina Marotti
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Eirini Kostakou
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Chris Carlin
- Dept. of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Stephanie Lua
- Dept. of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Suveer Singh
- Department of Respiratory and Critical Care Medicine, Chelsea & Westminster Hospital, London, SW10 9NH, UK
| | - Andrew Bentley
- Department of Intensive Care & Respiratory Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, WC2R 2LS, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St. Thomas' NHS Trust and King's College London, London, WC2R 2LS, UK
| | - Luigi Camporota
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK
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Tong Y, Cui J, Chai D. Effect of Respiration Training-Assisted Western Medicine Therapy on Activity Tolerance, Pulmonary Function, and Quality of Life of Chronic Obstructive Pulmonary Disease Patients in the Stable Phase. J Healthc Eng 2022; 2022:9427602. [PMID: 35399844 DOI: 10.1155/2022/9427602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
Objective To explore the effect of respiration training-assisted western medicine therapy on activity tolerance, pulmonary function, and quality of life (QOL) of chronic obstructive pulmonary disease (COPD) patients in the stable phase. Methods The medical data of 90 COPD patients in the stable phase treated in the respiratory medicine of our hospital (November 2020-November 2021) were chosen for the retrospective analysis, and the patients were split into group A (n = 45, respiration training-assisted western medicine therapy) and group B (n = 45, western medicine therapy) according to the clinical reception order, so as to record and compare the activity tolerance, lung function, and QOL between the groups after intervention. Results Compared with group B after intervention, group A showed greatly longer mean 6-min walking distance, significantly lower St. George's Respiratory Questionnaire (SGRQ) score, significantly higher specific airway conductance (sGAW) and level values of various lung function indicators, and significantly lower level values of airway resistance (RAW) and specific airway resistance (sRAW) (p all<0.001); the total effective rate was significantly higher in group A (p < 0.05). Conclusion Respiration training-assisted western medicine therapy is a dependable way to improve the activity tolerance of COPD patients in the stable phase, and such strategy largely improves patients' lung function and QOL. Deeper studies will be helpful to establish a preferable solution for such patients.
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Abstract
PURPOSE OF REVIEW Extracorporeal support allows ultraprotective controlled and assisted ventilation, which can prevent lung and diaphragm injury. We focused on most recent findings in the application of extracorporeal support to achieve lung protection and diaphragm- protection, as well as on relevant monitoring. RECENT FINDINGS A recent randomized trial comparing the efficacy of extracorporeal support as a rescue therapy to conventional protective mechanical ventilation was stopped for futility but post hoc analyses suggested that extracorporeal support is beneficial for patients with very severe acute respiratory distress syndrome. However, the optimal ventilation settings during extracorporeal support are still debated. It is conceivable that they should enable the highest amount of CO2 removal with lowest mechanical power.Extracorporeal CO2 removal can minimize acidosis and enable the use of ultra-protective lung ventilation strategies when hypoxemia is not a major issue. Moreover, it can protect lung and diaphragm function during assisted ventilation through control of the respiratory effort.Lung mechanics, gas exchange, diaphragm electrical activity, ultrasound, electrical impedance tomography could be integrated into clinical management to define lung and diaphragm protection and guide personalized ventilation settings. SUMMARY Technological improvement and the latest evidence indicate that extracorporeal support may be an effective tool for lung and diaphragm protection.
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Zhao K, Tu C, Liang K, Li Y, Yu Y. Long noncoding RNA MCM3AP antisense RNA 1 is downregulated in chronic obstructive pulmonary disease and regulates human bronchial smooth muscle cell proliferation. J Int Med Res 2020; 48:300060520935215. [PMID: 32940099 PMCID: PMC7503009 DOI: 10.1177/0300060520935215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/26/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the involvement of MCM3AP antisense RNA 1 (MCM3AP-AS1) in chronic obstructive pulmonary disease (COPD). METHODS The expression levels of plasma MCM3AP-AS1 in COPD patients and healthy controls were measured by quantitative PCR before treatment and at 3 months after the initiation of treatment (post-treatment) from COPD patients. The role of MCM3AP-AS1 in regulating the proliferation of human bronchial smooth muscle cells (HBSMCs) was explored by a cell proliferation assay. RESULTS We found that MCM3AP-AS1 expression was downregulated in the plasma of COPD patients compared with controls. Among controls, MCM3AP-AS1 expression was lower in smokers than never-smokers. A 3-year follow-up study showed that, among smokers, patients with low MCM3AP-AS1 expression showed a higher incidence of COPD. After treatment for COPD, MCM3AP-AS1 expression significantly increased. The cell proliferation assay showed that MCM3AP-AS1 overexpression decreased the proliferation rate of HBSMCs. MCM3AP-AS1 silencing had the opposite effect. CONCLUSIONS MCM3AP-AS1 appears to be downregulated in COPD and to predict its occurrence. MCM3AP-AS1 regulates the proliferation of HBSMCs to participate in airway remodeling.
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Affiliation(s)
| | | | - Kaiyi Liang
- Department of Radiology, Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, P. R. China
| | - Ying Li
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, P. R. China
| | - Yanfang Yu
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, P. R. China
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Peñuelas Ó, Frutos-Vivar F, Mancebo J. Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Exacerbations. Semin Respir Crit Care Med 2020; 41:798-805. [PMID: 32746470 DOI: 10.1055/s-0040-1714396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality, and health care costs worldwide. Although there exist some heterogeneity between patients, the course of COPD is characterized by recurrent acute exacerbations, which are among the most common causes of medical admission to hospital. Patients with frequent exacerbations have accelerated lung function decline, worse quality of life, and greater mortality. Therefore, interest is growing in assessing the effectiveness of interventions used to treat exacerbations. The present review summarizes the current evidence regarding the use of ventilatory management to treat COPD and the implementation of novel cost-effective strategies, such as high-flow oxygenation or extracorporeal carbon dioxide removal to improve clinical outcomes and functional recovery in this disease and to reduce the associated costs.
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Affiliation(s)
- Óscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Fernando Frutos-Vivar
- Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Jordi Mancebo
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Abstract
TECHNOLOGY Extracorporeal carbon dioxide removal means the removal of carbon dioxide from the blood across a gas exchange membrane without substantially improving oxygenation. Carbon dioxide removal is possible with substantially less extracorporeal blood flow than needed for oxygenation. Techniques for extracorporeal carbon dioxide removal include (1) pumpless arterio-venous circuits, (2) low-flow venovenous circuits based on the technology of continuous renal replacement therapy, and (3) venovenous circuits based on extracorporeal membrane oxygenation technology. INDICATIONS Extracorporeal carbon dioxide removal has been shown to enable more protective ventilation in acute respiratory distress syndrome patients, even beyond the so-called "protective" level. Although experimental data suggest a benefit on ventilator induced lung injury, no hard clinical evidence with respect to improved outcome exists. In addition, extracorporeal carbon dioxide removal is a tool to avoid intubation and mechanical ventilation in patients with acute exacerbated chronic obstructive pulmonary disease failing non-invasive ventilation. This concept has been shown to be effective in 56-90% of patients. Extracorporeal carbon dioxide removal has also been used in ventilated patients with hypercapnic respiratory failure to correct acidosis, unload respiratory muscle burden, and facilitate weaning. In patients suffering from terminal fibrosis awaiting lung transplantation, extracorporeal carbon dioxide removal is able to correct acidosis and enable spontaneous breathing during bridging. Keeping these patients awake, ambulatory, and breathing spontaneously is associated with favorable outcome. COMPLICATIONS Complications of extracorporeal carbon dioxide removal are mostly associated with vascular access and deranged hemostasis leading to bleeding. Although the spectrum of complications may differ, no technology offers advantages with respect to rate and severity of complications. So called "high-extraction systems" working with higher blood flows and larger membranes may be more effective with respect to clinical goals.
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Affiliation(s)
- Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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