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Options in extracorporeal support of multiple organ failure
Multiorgan failure is among the most frequent reasons of death in critically ill patients. Based on extensive and long-term use of renal replacement therapy, extracorporeal organ support became available for other organ failures. Initially, most of these techniques (e.g. extracorporeal membrane oxyg...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Medizin
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220977/ https://www.ncbi.nlm.nih.gov/pubmed/32095838 http://dx.doi.org/10.1007/s00063-020-00658-3 |
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author | Huber, W. Ruiz de Garibay, A. P. |
author_facet | Huber, W. Ruiz de Garibay, A. P. |
author_sort | Huber, W. |
collection | PubMed |
description | Multiorgan failure is among the most frequent reasons of death in critically ill patients. Based on extensive and long-term use of renal replacement therapy, extracorporeal organ support became available for other organ failures. Initially, most of these techniques (e.g. extracorporeal membrane oxygenation, extracorporeal CO(2) removal [ECCO2R] and extracorporeal liver support) were used as stand-alone single organ support systems. Considering multiple interactions between native organs (“crosstalk”), combined or integrated extracorporeal organ support (ECOS) devices are intriguing. The concept of multiple organ support therapy (MOST) providing simultaneous and combined support for different failing organs was described more than 15 years ago by Ronco and Bellomo. This concept also implicates overcoming the “compartmentalized” approach provided by different single organ specialized professionals by a multidisciplinary and multiprofessional strategy. The idea of MOST is supported by the failure of several recent studies on single organ support including liver and lung support. Improvement of outcome by ECOS necessarily depends on optimized patient selection, integrated organ support and limitation of its side effects. This implicates challenges for engineers, industry and healthcare professionals. From a technical viewpoint, modular combination of pre-existing technologies such as renal replacement, albumin-dialysis, ECCO2R and potentially cytokine elimination can be considered as a first step. While this allows for stepwise and individual combination of standard organ support facilities, it carries the disadvantage of large extracorporeal blood volume and surfaces as well as additive costs. The more intriguing next step is an integrated platform providing the capacity of multiple organ support within one device. (This article is freely available.) |
format | Online Article Text |
id | pubmed-7220977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Medizin |
record_format | MEDLINE/PubMed |
spelling | pubmed-72209772020-05-15 Options in extracorporeal support of multiple organ failure Huber, W. Ruiz de Garibay, A. P. Med Klin Intensivmed Notfmed Review Articles Multiorgan failure is among the most frequent reasons of death in critically ill patients. Based on extensive and long-term use of renal replacement therapy, extracorporeal organ support became available for other organ failures. Initially, most of these techniques (e.g. extracorporeal membrane oxygenation, extracorporeal CO(2) removal [ECCO2R] and extracorporeal liver support) were used as stand-alone single organ support systems. Considering multiple interactions between native organs (“crosstalk”), combined or integrated extracorporeal organ support (ECOS) devices are intriguing. The concept of multiple organ support therapy (MOST) providing simultaneous and combined support for different failing organs was described more than 15 years ago by Ronco and Bellomo. This concept also implicates overcoming the “compartmentalized” approach provided by different single organ specialized professionals by a multidisciplinary and multiprofessional strategy. The idea of MOST is supported by the failure of several recent studies on single organ support including liver and lung support. Improvement of outcome by ECOS necessarily depends on optimized patient selection, integrated organ support and limitation of its side effects. This implicates challenges for engineers, industry and healthcare professionals. From a technical viewpoint, modular combination of pre-existing technologies such as renal replacement, albumin-dialysis, ECCO2R and potentially cytokine elimination can be considered as a first step. While this allows for stepwise and individual combination of standard organ support facilities, it carries the disadvantage of large extracorporeal blood volume and surfaces as well as additive costs. The more intriguing next step is an integrated platform providing the capacity of multiple organ support within one device. (This article is freely available.) Springer Medizin 2020-02-24 2020 /pmc/articles/PMC7220977/ /pubmed/32095838 http://dx.doi.org/10.1007/s00063-020-00658-3 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Review Articles Huber, W. Ruiz de Garibay, A. P. Options in extracorporeal support of multiple organ failure |
title | Options in extracorporeal support of multiple organ failure |
title_full | Options in extracorporeal support of multiple organ failure |
title_fullStr | Options in extracorporeal support of multiple organ failure |
title_full_unstemmed | Options in extracorporeal support of multiple organ failure |
title_short | Options in extracorporeal support of multiple organ failure |
title_sort | options in extracorporeal support of multiple organ failure |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220977/ https://www.ncbi.nlm.nih.gov/pubmed/32095838 http://dx.doi.org/10.1007/s00063-020-00658-3 |
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