Peritoneal Oxygenation as a Novel Technique for Extrapulmonary Ventilation; A Review and Discussion of the Literature

HIGHLIGHTS: What are the main findings? Peritoneal oxygenation has significant potential for treatment of acute respiratory distress syndrome patients. It could offer an effective treatment for rescue ventilation in critically unwell patients. Further large animal studies are needed with further refinement of currently available techniques. What is the implication of the main finding? We propose the further development of techniques and animal models with an eventual goal of evaluation in humans. Peritoneal oxygenation is a promising alternative to rescue ventilation is cases of extreme hypoxia. ABSTRACT: The COVID-19 crisis has highlighted the difficulties that might occur when attempting to oxygenate patients who have suffered a severe pulmonary insult, including in the development of acute respiratory distress syndrome (ARDS). Traditional mechanical ventilation (MV) is effective; however, in severe cases of hypoxia, the use of rescue therapy, such as extracorporeal membrane oxygenation (ECMO), may be required but is also associated with significant complexity and complications. In this review, we describe peritoneal oxygenation; a method of oxygenation that exploits the peritoneum’s gas exchange properties in a fashion that is similar to peritoneal dialysis and has shown considerable promise in animal models. We have conducted a review of the available literature and techniques, including intraperitoneal perfluorocarbons, intraperitoneal jet ventilation, a continuous low-pressure oxygen system (PEROX) and the use of phospholipid-coated oxygen microbubbles (OMBs) through peritoneal microbubble oxygenation (PMO). We conclude that peritoneal oxygenation is a promising technique that warrants further investigation and might be used in clinical settings in the future.