Support therapy for lung failure

The desire to find a way to support a failing lung has existed since the first physician watched his patient succumb to an acute lung injury; however, practical means to support the failing lung are relatively new. Most of the ideas, techniques, and equipment grew as an extension of cardiopulmonary bypass. From this core technology, many spin-off techniques have been developed. In this chapter we will discuss and evaluate the historical and current trends in lung support, from total gas exchange devices to devices meant only to augment gas exchange. Although some of these techniques have been around for 35 years, few have undergone rigorous scientific validation. With this in mind, we will highlight the landmark trials and present a balanced argument for their use in patients. It should be noted that the essence of evidence based medicine is data; in order for sufficient data to exist, a technology must be mature, standardized and disseminated. Many of the extracorporeal techniques in this chapter are cutting edge and, as such, do not have the necessary trials to generate the amount of data to allow evaluation in an evidence based manner. A grade of weak recommendation is not equivalent to harmful and should be viewed as a lack of data as opposed to a judgment on the efficacy of the technique.