Critical care medicine: extracorporeal oxygenation is feasible in Brazil? - Critical Care Science (CCS)
Ventilatory support has been a major reason for hospitalization in intensive care units (ICU) since the creation of these units, which came about precisely for that immediate need during the polio epidemic in Europe.( , ) In 1967, Ashbaugh described a series of severe cases marked by respiratory failure, cyanosis, hypoxemia refractory to oxygen therapy and high mortality, a condition that became known as acute respiratory distress syndrome (ARDS).( ) Almost 50 years after the syndrome was first identified, the treatment of ARDS is still a major challenge for intensive care medicine and continues to be associated with high mortality and morbidity.( , ) Several therapeutic modalities have been proposed, with variable results, including in terms of cost. These therapies involve mechanical ventilation strategies,( – ) patient positioning,( ) and the use of medications and gas mixtures,( – ) among other techniques. Recently, extracorporeal membrane oxygenation (ECMO) therapy has once again become popular.( , )
ECMO, arising from surgery requiring cardiopulmonary bypass, has been used as a treatment for ARDS since the 1970s,( ) with unfavorable initial results.( , ) However, the therapy was never definitively abandoned and, in 2009, with the influenza A (H1N1) pandemic, the use of ECMO showed more promising results in large case series in developed countries.( ) The exchange of information between centers with experience in the method and professional qualifications clearly contributed to these results. In Brazil, the Park group( ) and others( ) have demonstrated the feasibility of using the technique to support patients with ARDS refractory to conventional treatment in our units. However, in our country, this know-how is restricted to a few groups, and the use of ECMO in most services remains just a possibility.
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Ventilatory support has been a major reason for hospitalization in intensive care units (ICU) since the creation of these units, which came about precisely for that immediate need during the polio epidemic in Europe.( , ) In 1967, Ashbaugh described a series of severe cases marked by respiratory failure, cyanosis, hypoxemia refractory to oxygen therapy and high mortality, a condition that became known as acute respiratory distress syndrome (ARDS).( ) Almost 50 years after the syndrome was first identified, the treatment of ARDS is still a major challenge for intensive care medicine and continues to be associated with high mortality and morbidity.( , ) Several therapeutic modalities have been proposed, with variable results, including in terms of cost. These therapies involve mechanical ventilation strategies,( - ) patient positioning,( ) and the use of medications and gas mixtures,( - ) among other techniques. Recently, extracorporeal membrane oxygenation (ECMO) therapy has once again become popular.( , )
ECMO, arising from surgery requiring cardiopulmonary bypass, has been used as a treatment for ARDS since the 1970s,( ) with unfavorable initial results.( , ) However, the therapy was never definitively abandoned and, in 2009, with the influenza A (H1N1) pandemic, the use of ECMO showed more promising results in large case series in developed countries.( ) The exchange of information between centers with experience in the method and professional qualifications clearly contributed to these results. In Brazil, the Park group( ) and others( ) have demonstrated the feasibility of using the technique to support patients with ARDS refractory to conventional treatment in our units. However, in our country, this know-how is restricted to a few groups, and the use of ECMO in most services remains just a possibility.
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