Critical care medicine
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Critical care medicine · Mar 2005
ReviewHigh-frequency oscillatory ventilation in adults: respiratory therapy issues.
To summarize clinical information and assessment techniques relevant to respiratory therapists caring for adult patients on high-frequency oscillatory ventilation (HFOV). ⋯ Respiratory therapy assessment and procedural skills are essential in providing optimal care to adult patients on HFOV.
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To review the technique and clinical application of high-frequency percussive ventilation in critically ill patients. ⋯ High-frequency percussive ventilation has been shown to provide favorable gas exchange in several well-defined patient populations. It reliably improves oxygenation and provides adequate ventilation at lower peak pressures than conventional ventilation. Adequately powered, randomized, prospective studies demonstrating significant mortality benefit have not yet been performed.
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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
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.
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Critical care medicine · Mar 2005
Review Comparative StudyOther approaches to open-lung ventilation: airway pressure release ventilation.
To review the use of airway pressure release ventilation (APRV) in the treatment of acute lung injury/acute respiratory distress syndrome. ⋯ APRV may offer potential clinical advantages for ventilator management of acute lung injury/acute respiratory distress syndrome and may be considered as an alternative "open lung approach" to mechanical ventilation. Whether APRV reduces mortality or increases ventilator-free days compared with a conventional volume-cycled "lung protective" strategy will require future randomized, controlled trials.