Acute Respiratory Failure: Ventilatory Support and Extracorporeal Membrane Oxygenation (ECMO)

Acute respiratory failure, either hypoxemic or hypercapnic, arises as the consequence of an inadequate response to the respiratory workload demanded by the organism. Several, often interlaced, factors contribute to the pathophysiology of this acute syndrome, whose treatment is essentially based on the resolution of the underlying critical illness. However, the use of ventilatory support might sustain or completely replace lung function and allow the patient more time to be treated. The pursuit of a noninvasive ventilatory strategy can be considered as a first-line option. Nevertheless, endotracheal intubation and invasive mechanical ventilation should be initiated in case of a persisting or progressive condition. The aim of mechanical ventilation is to maintain an adequate alveolar ventilation and oxygen delivery, thus restoring acid-base balance and reducing the patient’s work of breathing. Among others, the well-known risk of ventilator-induced lung injury must be taken into account. Accordingly, a protective ventilatory approach must be adopted. In case of a severe refractory disease, extracorporeal membrane oxygenation (ECMO) might be the only possibility to rescue patients with an otherwise fatal respiratory failure. Again, bypassing lung function through the use of an artificial lung must be weighed against the challenges and hazards of such an advanced life support treatment.