Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Children who require mechanical ventilation represent a high-risk population with significant morbidity and mortality. Experienced handling of conventional therapies including high frequency oscillation ventilation and initiation of newer treatment options such as surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology in patients with respiratory failure refractory to maximal medical therapy. ⋯ Despite limited evidence and relatively few randomized trials in children, ECMO remains the safety net for patients with severe respiratory failure. Experience as measured by the annual number of cases plays an important role for the quality of results.
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Med Klin Intensivmed Notfmed · Sep 2015
Review[Lung and kidney failure. Pathogenesis, interactions, and therapy].
The lungs and kidneys represent the most often affected organs (acute respiratory distress syndrome, ARDS or kidney failure) in multiple organ failure (MOF) due to shock, trauma, or sepsis with a still unacceptable high mortality for both organ failures. ⋯ The organ replacement therapies used in both organ failures have the potential to further injure the other organ (ventilator trauma, dialyte trauma). On the other hand, renal replacement therapy can have positive effects on lung injury by restoring volume and acid-base homeostasis. The new development of "low-flow" extracorporeal CO2 removal on renal replacement therapy platforms may further help to decrease ventilator trauma in the future.