Critical care clinics
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The rational for using closed loop ventilation is becoming strong and stronger. Studies are now available supporting the hypothesis that patient outcome is improved by using closed loop ventilation. ⋯ Introducing novel graphical user interfaces and providing data displays that are pertinent, integrative and dynamic will reduce cognitive resources of the clinician and have the potential to make ventilation safer. They may be the key to adopt closed loop ventilation in everyday practice.
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Critical care clinics · Apr 2007
Review"The use of positive end-expiratory pressure in mechanical ventilation".
An improvement in oxygenation for patients who have acute respiratory failure using PEEP was described close to 40 years ago. Since then, a considerable amount of research has allowed clinicians to use this therapeutic modality in various ways. In patients receiving mechanical ventilation, the term positive end-expiratory pressure (PEEP) refers to pressure in the airway at the end of passive expiration that exceeds atmospheric pressure. ⋯ It has been shown that this helps the respiratory muscles to decrease the work of breathing and the amount of infiltrated-atelectatic tissues. The beneficial effects of the use of PEEP include: the improvement of oxygenation, recruitment of lung units, and improvement of compliance. Other effects can be adverse, like decreasing cardiac output, increased risk of barotrauma, and the interference with assessment of hemodynamic pressures.
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Critical care clinics · Apr 2007
ReviewThe open lung concept of mechanical ventilation: the role of recruitment and stabilization.
This article describes the pathophysiologic basis and clinical role for lung recruitment maneuvers. It reviews the literature and presents the authors' clinical experience of over 15 years in the collaboration between Erasmus MC and the University of Rochester. The authors are hopeful that these lung-protective strategies are presented in a useful format that may be useful to the practicing intensivist, thus bringing laboratory and clinical research to bedside practice.
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Mechanical ventilation, although essential in taking care of acute lung injury and widely used during surgical procedures worldwide, remains a highly debated field. Clinical trials in the last decade have shown convincingly that mechanical ventilation can result in additional mortality in patients with acute lung injury. This understanding has resulted in a resurged interest in mechanical ventilation, and especially in techniques and strategies to further improve mechanical ventilation. This article discusses physiological principles to improve the understanding of mechanical ventilation.
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Postoperative lung injury is a common, although decreasing, complication of cardiac surgery. This article discusses various means to prevent and minimize postoperative lung injury. These include lung-protective strategies, pharmacologic strategies, and mechanical ventilation.