Current opinion in critical care
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Curr Opin Crit Care · Feb 2006
ReviewThe impact of spontaneous breathing during mechanical ventilation.
In patients with acute respiratory distress syndrome, controlled mechanical ventilation is generally used in the initial phase to ensure adequate alveolar ventilation, arterial oxygenation, and to reduce work of breathing without causing further damage to the lungs. Although introduced as weaning techniques, partial ventilator support modes have become standard techniques for primary mechanical ventilator support. This review evaluates the physiological and clinical effects of persisting spontaneous breathing during ventilator support in patients with acute respiratory distress syndrome. ⋯ In view of the recently available data, it can be concluded that maintained spontaneous breathing during mechanical ventilation should not be suppressed even in patients with severe pulmonary functional disorders.
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Curr Opin Crit Care · Feb 2006
ReviewFebrile respiratory illness in the intensive care unit setting: an infection control perspective.
We have examined studies published since the severe acute respiratory syndrome outbreak that elucidate the mode of transmission of respiratory pathogens and the optimal means of interrupting their transmission, focusing on transmission in the intensive care unit. ⋯ Most respiratory pathogens can be transmitted by more than one route. Despite this, healthcare worker awareness of clinical syndromes associated with respiratory pathogens that require airborne precautions, combined with the use of standard precautions for all patients, and contact/droplet precautions for patients with undifferentiated febrile respiratory illness should be effective in interrupting the transmission of respiratory pathogens within the intensive care unit.
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Curr Opin Crit Care · Feb 2006
ReviewDeveloping and managing a team to participate in trials involving acute respiratory failure: advice for the inexperienced.
Conducting large-scale clinical trials in the field of acute respiratory failure requires substantial collaboration. Teamwork is still in its infancy within the realm of clinical research. This review evaluates the need for and grassroots process of teamwork and considers the challenges facing teamwork in the specific context of conducting acute respiratory failure research today. ⋯ As large-scale (oftentimes international) multicenter trials are increasingly providing answers to our research questions, greater emphasis must be placed on team building within the clinical research environment. An urgent need for further work in this area is revealed. Critical care fellowships should integrate teamwork skills into the curriculum.
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Curr Opin Crit Care · Feb 2006
ReviewDesigning clinical trials in acute lung injury/acute respiratory distress syndrome.
To review the implications of recent literature for clinical trial design in acute lung injury/acute respiratory distress syndrome (ARDS). ⋯ Clinical trial design in acute lung injury/acute respiratory distress syndrome faces many challenges. Although we have learned much from past trials, persistent design dilemmas must be addressed for future trials.
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In recent years, research has led to changes in the practice of mechanical ventilation that are associated with improved patient outcome. Unfortunately, many of these recommendations have not been consistently translated to the bedside. Education is an important component of change management, and thus a review of successful education practices, including those that incorporate advances in technology, is timely. ⋯ A coordinated approach to education about mechanical ventilation should be considered to ensure optimal patient care in a wide variety of clinical settings. Further research is necessary to determine the important characteristics inherent in successful education initiatives, particularly those incorporating new technology such as simulation.