Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction

Stefano Romagnoli, Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

In modern intensive care medicine, lungs and kidneys frequently are involved in the context of multiorgan failure. When organ dysfunction occurs, the primary clinical management of critically ill patients is based on support/replacement of organ function until recovery. Mechanical ventilation is the first-line intervention in case of respiratory failure, but in most severe cases may, itself, cause ventilator-induced lung injury. The same inflammatory mechanism also may harm the kidney through mediator spillover from the injured lungs into the bloodstream. To limit the deleterious effects of mechanical ventilation and avoid excessive carbon dioxide accumulation, devices for extracorporeal CO2 removal (ECCO2R), have been developed. Some consistent clinical experience currently has been reached in patients with obstructive pulmonary disease and acute respiratory distress syndrome. Interestingly, ECCO2R recently has been coupled with continuous renal replacement therapy systems into specific lung-renal support. The results from the first experimental and clinical applications are encouraging: it is expected that a system including continuous renal replacement therapy and ECCO2R will develop from the current pioneering attempts into a feasible multiple-organ support platform to become commonly used as a routine tool in intensive care units. This review focuses on recent literature and clinical applications of renal-pulmonary support with specific attention to technical aspects of the most recent materials and devices.

Original languageEnglish
JournalSeminars in Nephrology
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Kidney
Lung
Renal Replacement Therapy
Artificial Respiration
Ventilator-Induced Lung Injury
Obstructive Lung Diseases
Equipment and Supplies
Recovery of Function
Adult Respiratory Distress Syndrome
Therapeutics
Critical Care
Critical Illness
Carbon Dioxide
Respiratory Insufficiency
Intensive Care Units
Medicine

Keywords

  • Continuous renal replacement therapy
  • CRRT
  • ECCOR
  • Extracorporeal CO removal
  • Extracorporeal membrane oxygenation
  • MOF
  • Multiorgan failure

ASJC Scopus subject areas

  • Nephrology

Cite this

Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction. / Romagnoli, Stefano; Ricci, Zaccaria; Ronco, Claudio.

In: Seminars in Nephrology, 2016.

Research output: Contribution to journalArticle

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