Critical care medicine
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Critical care medicine · Mar 2005
Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs.
To describe the characteristics of a large cohort of cancer patients receiving mechanical ventilation for >24 hrs and to identify clinical features predictive of in-hospital death. ⋯ Severity of acute organ failures, poor performance status, cancer status, and older age were the main determinants of mortality. The appropriate use of such easily available clinical characteristics may avoid forgoing intensive care for patients with a chance of survival.
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Critical care medicine · Mar 2005
ReviewUse of high-frequency oscillatory ventilation in burn patients.
Patients with major burn injuries frequently develop acute respiratory distress syndrome (ARDS). High-frequency oscillatory ventilation (HFOV) has been used successfully in our regional burn center since 1999 for the management of oxygenation failure secondary to ARDS and as a method of intraoperative ventilation to allow surgical burn wound excision to proceed, despite the presence of severe ARDS. ⋯ HFOV has been an indispensable ventilation modality in our burn center, and has played an important role in reversing oxygenation failure in patients with ARDS and in facilitating early excision and closure of the burn wound in these patients.
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Critical care medicine · Mar 2005
ReviewHigh-frequency oscillatory ventilation: mechanisms of gas exchange and lung mechanics.
Overview of the mechanisms governing gas transport, mechanical factors influencing the transmission of pressure and flow to the lung, and the measurement of lung mechanics during high-frequency oscillatory ventilation (HFOV) in acute respiratory distress syndrome. ⋯ Awareness of the different mechanisms governing gas transport and the prevailing lung mechanics during HFOV represents essential background for the physician planning to use this mode of ventilation in the adult patient. Monitoring of lung volume, respiratory mechanics, and ventilation homogeneity may facilitate individual optimization of HFOV ventilatory settings in the future.
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Critical care medicine · Mar 2005
ReviewHigh-frequency oscillatory ventilation: lessons learned from mechanical test lung models.
Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. ⋯ Mechanical test lung and artificial trachea simulations may provide useful information on the interaction of HFOV with altered lung mechanics and may contribute to the formulation of HFOV clinical strategies. Important limitations of these models include absence of gas exchange, histologic and biologic markers, or hemodynamic data.
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Critical care medicine · Mar 2005
ReviewComputed tomography scan assessment of lung volume and recruitment during high-frequency oscillatory ventilation.
This review describes how computed tomography has increased our understanding of the pathophysiology of acute respiratory distress syndrome. It summarizes current knowledge about lung volume changes and alveolar recruitment during high-frequency oscillatory ventilation (HFOV) assessed by computed tomography (CT), outlines potential problems when comparing HFOV with conventional ventilation (CV) as a result of the different pressure-time profiles, and describes future research directions. ⋯ CT is a valuable tool to quantify recruitment and overinflation during HFOV. Additional studies are needed to better characterize the specific effects of HFOV on lung volume and morphology.