Publication date: Available online 12 May 2017
Source:Revue des Maladies Respiratoires
Author(s): J. Reeb, A. Olland, S. Renaud, O. Collange, X. Delabranche, N. Santelmo, F. Meziani, P.-M. Mertes, G. Massard, P.-E. Falcoz
IntroductionEn chirurgie thoracique, l'extracorporeal life support (ECLS) représente un arsenal thérapeutique indiqué en cas de défaillance de l'appareil respiratoire ou comme support mécanique pour un acte thérapeutique. Les objectifs de cette revue générale sur l'ECLS en chirurgie thoracique sont de décrire le rationnel des techniques d'ECLS disponibles, de présenter les indications d'ECLS lors de défaillances de l'appareil respiratoire et aussi de démontrer l'intérêt de l'ECLS pour pratiquer l'ECLS en chirurgie thoracique selon une médecine fondée sur les preuves.État des connaissancesL'ECLS doit se pratiquer dans des centres experts. Dans le syndrome de défaillance respiratoire aiguë sévère et réfractaire, l'ECLS permet de mettre au repos les poumons en pratiquant une ventilation protectrice. En transplantation pulmonaire, l'ECLS peut être pratiquée avec de bons résultats en pont à la transplantation pulmonaire, en temps que support cardiorespiratoire peropératoire et en pont à la récupération en cas de dysfonction primaire du greffon pulmonaire. L'ECLS en tant que support à un acte thérapeutique trachéobronchique et/ou chez un insuffisant respiratoire sévère est faisable sans majorer significativement le risque périopératoire.PerspectivesLes indications d'ECLS vont accroître dans le temps sous l'impulsion des centres experts. Dans les années à venir, les progrès des techniques et de l'ingénierie ainsi que des connaissances approfondies permettront l'amélioration du pronostic des patients atteints de défaillance respiratoire sous assistance mécanique. Des études prospectives multicentriques et randomisées affineront les indications et les stratégies de prise en charge globale de ces patients.ConclusionL'ECLS est un moyen thérapeutique améliorant le pronostic de patients atteints ou soumis aux risques de défaillance respiratoire.IntroductionIn thoracic surgery, extracorporeal life support (ECLS) technologies are used in cases of severe and refractory respiratory failure or as intraoperative cardiorespiratory support. The objectives of this review are to describe the rationale of ECLS techniques, to review the pulmonary diseases potentially treated by ECLS, and finally to demonstrate the efficacy of ECLS, using recently published data from the literature, in order to practice evidence based medicine.State of the artECLS technologies should only be undertaken in expert centers. ECLS allows a protective ventilatory strategy in severe ARDS. In the field of lung transplantation, ECLS may be used successfully as a bridge to transplantation, as intraoperative cardiorespiratory support or as a bridge to recovery in cases of severe primary graft dysfunction. In general thoracic surgery, ECLS technology seems to be safe and efficient as intraoperative respiratory support for tracheobronchial surgery or for severe respiratory insufficiency, without significant increase in perioperative risk.PerspectiveThe indications for ECLS are going to increase. Future improvements both in scientific knowledge and bioengineering will improve the prognosis of patients treated with ECLS for respiratory failure. Multicenter randomized controlled trials will refine the indications for ECLS and improve the global care strategies for these patients.ConclusionECLS is an efficient therapeutic strategy that will improve the prognosis of patients suffering from, or exposed to, the risks of severe respiratory failure.
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ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
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00306932607174
alsfakia@gmail.com
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Τρίτη 16 Μαΐου 2017
Support extracorporel en chirurgie thoracique : quelles indications et quels intérêts ?
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