Browsing by Author "Pfeifer, Michael"

Background: Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients. Methods: This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n=7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n=2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n=11) consisted of patients on invasive ventilation who had failed attempts to wean. Results: The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 +/- 73.7 mL/min, and ECCO2R was 82.5 +/- 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P<.003) with application of the device from 78.9 +/- 16.8 mm Hg to 65.9 +/- 11.5 mm Hg. In group 3, three Patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization. Conclusions: This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure. Trial registry: ClinicalTrials.gov; No.: NCT00987740 and 01021605; URL: www.clinicaltrials.gov CHEST 2013; 143(3):678-686

Zusammenfassung Das vorliegende Positionspapier (AWMF) zur Therapie der Sarkoidose der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) wurde 2023 als deutschsprachige Ergänzung und Aktualisierung der internationalen Leitlinien der European Respiratory Society (ERS) aus dem Jahre 2021 verfasst. Sie enthält 5 im Konsensusverfahren abgestimmte Empfehlungen in Form von PICO-Fragen (Patients, Intervention, Comparison, Outcomes), die im Hintergrundtext der 4 Kapitel erläutert werden: Diagnosesicherung und Monitoring der Erkrankung unter Therapie, allgemeine Therapieempfehlungen, Therapie der Hautsarkoidose, Therapie der kardialen Sarkoidose.