A new approach to the prevention and treatment of acute pulmonary insufficiency

The authors have shown that a new approach to pulmonary management can have a major effect on prevention of lung disease, or the progression of the disease in respiratory failure. Hitherto, our mainstay in the management of acute pulmonary insufficiency both in adults and in neonates was mechanical pulmonary ventilators, or continuous positive airway pressure (CPAP). No doubt they still have their place if judiciously applied. Their use, however, must be tempered by knowledge that treatment by itself can lead to further evolution and exacerbation of pulmonary disease. So much so that once a fullblown pulmonary insufficiency has developed the chances for full recovery may be very slim. We believe, that apneic oxygenation with ECCO₂R in a select group of patients can have a place in the treatment and the prevention of pulmonary disease. This technique, or variants of the same, requires a low extracorporeal blood flow not very much higher than in routine hemodialysis. Because its complexity is even less than in hemodialysis as no dialysate is required, this technique should not be considered a last resort but should be considered sufficiently early to prevent the progression of the disease, exacerbated by untoward effects of mechanical pulmonary ventilation.