In the past, treatment of acute exacerbations of obstructive disease refractory to medical treatment was invasive mechanical ventilation. As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have aroused as an attractive option to avoid worsening respiratory failure and respiratory acidosis and potentially prevent, shorten the duration of invasive mechanical ventilation (IMV), and serve as rescue therapy in patients with exacerbation of COPD and asthma. In this review, we will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO2R in patients with severe exacerbations of these pathologies.
Part of the book: Advances in Extracorporeal Membrane Oxygenation
Sepsis and acute respiratory distress syndrome (ARDS) are life-threatening diseases with high mortality, around 40%, and morbidity in all the critical care units around the world. After decades of research, and numerous pre-clinical and clinical trials, sepsis and ARDS remain without a specific and effective pharmacotherapy and essentially the management remains supportive. Over the last years, cell therapies gained potential as a therapeutic treatment for ARDS and sepsis. Based on numerous pre-clinical studies, there is a growing evidence of the potential benefits of cell-based therapies for the treatment of sepsis and ARDS. Different cell subtypes have been used for the treatment of both syndromes; however, the major part of the studies is using mesenchymal stem/stromal cells (MSC). Also, other relevant groups performed some pre-clinical studies using induced pluripotent stem cells (iPSC) for the treatment of both syndromes and alveolar type II cells for ARDS treatment. Numerous questions need further study, including determining the best source for the progenitor cells isolation, their large-scale production, and cryopreservation. Also, the heterogeneity of patients with sepsis and ARDS is massive, and the stratification of the patients will help us to determine better the therapeutic effect of these cell therapies. In this review, we are going to describe briefly the different cell types, their potential sources, and characteristics and mechanism of action. We will review several pre-clinical and clinical studies in ARDS and sepsis.
Part of the book: Innovations in Cell Research and Therapy