Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jan 2000
Techniques for automated feedback control of mechanical ventilation.
Mechanical ventilators have become more sophisticated with the advent of microprocessor control. Advances in monitoring have also improved our ability to harmonize patient-ventilator interaction. The next obvious step in this technologic progression is to turn over some decision making to the ventilator. ⋯ An example is the automated control of pressure support to maintain a deired tidal volume. More sophisticated closed-loop techniques, such as proportional assist ventilation and adaptive support ventilation, not only monitor multiple input variables but also use closed-loop control of several variables. This article reviews the closed-loop ventilation modes currently available to clinicians.
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Despite recent advances in technology, the mortality rate for patients suffering from adult respiratory distress syndrome remains in the range of 40-50%. This high mortality rate may be in part related to complications from ventilator management, such as ventilator-induced lung injury. In these patients, adjunct therapies aiming at ameliorating ventilator-induced lung injury are being developed. This article discusses the rationale for use of pharmacologic adjunct therapies, including inhaled nitric oxide, surfactant replacement therapy, antioxidants, prostaglandins, and corticosteroids, in patients with acute lung injury, and reviews the effectiveness of these agents in human clinical trials to date.
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Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome common to a variety of pulmonary inflammatory disorders. It is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal airspaces. ⋯ Other imaging presentations consist of diffuse infiltrative opacities or focal pneumonia. Improvement with corticosteroids is usually spectacular, but relapses are common after stopping or while reducing treatment.