Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction

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.

Keywords: CRRT; ECCO(2)R; MOF; Multiorgan failure; continuous renal replacement therapy; extracorporeal CO(2) removal; extracorporeal membrane oxygenation.