Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jan 2001
Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction.
The intensivist should think of delirium, or acute central nervous system dysfunction, as the brain's form of "organ dysfunction.'' Delirium is extremely common in intensive care unit (ICU) patients due to factors such as comorbidity, critical illness, and iatrogenesis. This complication of hospital stay is extremely hazardous in older persons and is associated with prolonged hospital stays, institutionalization, and death. ⋯ More importantly, there are few studies that have included ICU patients in the assessment or prevention of delirium. This article reviews the definition and salient features of delirium, its primary risk factors, a newly validated instrument for delirium assessment that is being developed for ICU nurses and physicians, and pharmacological agents associated with the development of delirium and used in its management.
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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.
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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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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.