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Additional file 2. Ongoing research on ECCO2R Table S1: Ongoing clinical studies on the use of ECCO2R in COPD and Table S2: Ongoing clinical studies on the use of ECCO2R in ARDS.

Additional file 1. Pathophysiology of respiratory acidosis and Pathophysiology of COPD and Figure S1: Pathophysiology of COPD exacerbation.

Additional file of The use of extracorporeal CO2 removal in acute respiratory failure

Additonal file 1A. Panel Composition, Literature search

Additional file 7. PoCUS-empowered triage in respiratory failure during COVID-19 Pandemic. Conceptual framework of point-of-care ultrasound (PoCUS) use for the triage of dyspneic and/or hypoxemic patients, during the SARS-CoV-2 pandemic: the diagram does not represent an algorithm but rather a framework for potentially developing protocols according to local/institutional clinical practices, policies and regulations. It does not either provide a list of conclusive diagnosis or specific treatments, but suggests how to integrate at best PoCUS in the workflow of this specific setting

Additional file 1B. Consensus Methodology

Additional file 1C. Consensus Results and Summary Recommendations

The benefit of any hemodynamic monitoring technique is to provide reliable and reproducible information on the cardiocirculatory status of a patient in shock. The collected values will enable the intensivist to understand the hemodynamic conditions of the patient and to make more informed treatment decisions to optimize the hemodynamic status and improve the prognosis of the patient. Hemodynamic monitoring is required to assess systemic and regional tissue perfusion as the correction of circulatory instability and tissue hypoperfusion is essential to prevent the occurrence of multiple organ failure. Resuscitation is characterized by a very close temporal relationship between monitoring, decision-making, and treatment. Indeed, making prompt, appropriate management and diagnostic and therapeutic decisions in cases of hemodynamic instability reduces mortality of critically ill patients [1]. To make treatment decisions, the intensivist has an arsenal of monitoring devices. However, before using a device, it is imperative that the intensivist has sound knowledge of the pathophysiology of shock states to identify the parameters that he/she wants to monitor. Therefore, knowing the different hemodynamic monitoring parameters is important [2]. For instance, it is now established and accepted by clinicians that fluid responsiveness is determined by monitoring dynamic indices, not static indices [3]. In addition, it is becoming increasingly common for mechanically ventilated critically ill patients to not be curarized. This condition requires clinicians to adapt their practice and to use other tactics to help assess the volume status of their patients. This is particularly true with the passive leg raising maneuver. However, the issue at hand is the overall choice of monitoring technique. In the 1970s, the only advanced hemodynamic monitoring option was the pulmonary artery catheter. The use of the pulmonary artery catheter (PAC) has been challenged in recent years, and there has been debate regarding its impact on patient survival. Conflicting results have been published [5], though the widely varying conclusions are due to patient selection, incomplete information, and differences in specific treatment protocols (or lack thereof) [6]. In light of this and by following the developments in the industry, clinicians are now in favor of using less-invasive monitoring techniques. During the past few years, different techniques have been made commercially available. These devices are diverse in concept, design, and functionality but have more or less been shown to be reliable in clinical practice. Moreover, relative to the PAC, these devices are more easily handled, which could lead to their adoption and early application for use in large populations of at-risk patients or in patients with hemodynamic instability. However, for everyday use in clinical practice, the diversity of minimally invasive hemodynamic monitoring requires knowledge of a number of different techniques, their operating concepts, their settings, and their respective clinical validity. In the first part of the present book, we present the hemodynamic monitoring parameters available to the clinician and their pathophysiological importance. For instance, blood pressure is the basic parameter, but measuring the arterial tone is sometime also necessary [7]. Additionally, measuring the intravascular pressure [8], the cardiac output, and their derived parameters is essential to determine and manage a balance between oxygen supply and consumption [9]. In this regard, we review techniques for cardiac output measurements based on pulmonary thermodilution [10], transpulmonary thermodilution [11, 12], echocardiography [13, 14], and Doppler techniques [15]. We discuss the techniques based on calibrated and non-calibrated pulse contour analysis [16] and their limitations. Finally, we discuss the dynamic indices of fluid responsiveness and their clinical applications and issues. Geneva, Switzerland Raphael Giraud Karim Bendjelid

Pulmonary embolism remains an important clinical problem with a high mortality rate. The potential for sudden and fatal hemodynamic deterioration highlights the need for a prompt diagnosis and appropriate intervention. The purpose of the present case report is to describe a successful peri-operative veno-arterial extra corporeal membrane oxygenation (VA-ECMO) implantation for assumed massive pulmonary embolism associated with high hemodynamic instability and severe hypoxemia. A 52-year-old female victim of a motorcycle accident had been operated on for unstable fractures that required optimal repair. Despite subcutaneous administration of 40 mg enoxaparin on day 0 and day 1, the patient developed a massive pulmonary embolism leading to peri-operative pulseless activity. As intravenous thrombolysis was strictly contraindicated, a VA-ECMO was successfully implanted and permitted to stabilize the patient's hemodynamics. The hemodynamic and respiratory status improved by day 3, and the ECMO was removed. A vena cava filter was implanted before successful and definitive stabilization of the femoral fracture and the L2 fracture on days 4 and 5. The patient was able to be mobilized 2 days after the surgery and was transferred to a rehabilitation ward on day 15. At that time, her cognitive functions had fully recovered. ECMO can provide lifesaving hemodynamic and respiratory support in patients with massive pulmonary embolism who are too unstable to tolerate other interventions, who have failed other therapies or for whom other therapies are contraindicated.

After the implantation of a biventricular assist device hemodynamic evaluation is difficult. The device itself frequently does not report the real outflow as it does not take into account the native cardiac output. Other methods used for cardiac output measurements cannot be employed for technical reasons and/or because their measurements could be misleading. The consequences are twofold; firstly, cardiac output cannot be estimated with accuracy. Secondly, the adequacy of oxygen supply and demand cannot be assessed. In order to monitor the adequacy of cardiac output in patient with Berlin heart biventricular support, the authors propose an original non invasive method to measure mixed venous blood saturation.

Supplementary methods. (DOCX 15 kb)

Supplementary methods. (DOCX 15 kb)