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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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.
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Concepts of ventilator-induced lung injury have revolutionized our approach to the ventilatory management of patients with acute lung injury and acute respiratory distress syndrome over the past 10 years. The extension of these principles to patients with brain injuries is challenging, as many of them are out of keeping with usual brain-protective management. ⋯ In many patients with brain injuries and acute lung injury the goals of lung protection can be achieved without threatening cerebral perfusion. In patients with more refractory raised intracranial pressure the optimal balance between brain and lung is not well established. Further research is needed on lung-protective strategies in this vulnerable population.
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Curr Opin Crit Care · Feb 2006
ReviewThe support of severe respiratory failure beyond the hospital and during transportation.
Given the number and variety of calamities in the past few years, providing support for critically ill and injured casualties has become a global priority. This article reviews and describes the challenges faced in providing critical care and respiratory support in an austere environment and during medical transport. The primary focus to be discussed is mechanical ventilation. ⋯ The support of respiratory failure with mechanical ventilation during a disaster is complex and challenging. The key to success is pre-planning, flexibility, and portability. Programmes such as the Critical Care Aeromedical Transport Teams can be a useful model for the development of appropriate civil response capabilities in critical care for use during a disaster.
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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.