Current opinion in critical care
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The aim of this review is to describe ventilator-patient interaction, employing the equation of motion and the curves obtained by the ventilator. Practitioners confronted with mechanically ventilated patients every day in intensive care units should be able to sort out from all data available from modern ventilators those relevant for choosing a correct ventilatory strategy for each patient. ⋯ The equation of motion is described and dynamic and static respiratory mechanics are analysed to highlight all those data that can influence decision-making in setting mechanical or assisted ventilation in invasively and non-invasively ventilated patients.
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The coupling between ventilator delivered inspiratory flow and patient's demands both in terms of timing and drive is a challenging task that has become largely feasible in recent years. This review addresses the new advances to modulate and treat patient-ventilator dyssynchrony. ⋯ Patient-ventilator dyssynchrony may affect patients' outcome. New modes of assisted mechanical ventilation have been introduced and represent a major step forward in modulating patient-ventilator dyssynchrony.
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Accurate quantification of extravascular lung water is an important issue in the management of patients with pulmonary edema. The single transpulmonary thermal indicator method has been available since the late 1990s. Its simplicity and easy application make it clinically attractive. ⋯ Extravascular lung water can be considered a relevant parameter that contributes to rational management of fluid and vasoactive therapy of many critically ill patients and offers a fuller picture of their overall lung function.
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Curr Opin Crit Care · Feb 2007
ReviewInsights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning.
Mechanical ventilation is a common intervention provided by pediatric intensivists. This fact notwithstanding, the management of mechanical ventilation in pediatrics is largely guided by a few pediatric trials along with careful interpretation and application of adult data. ⋯ Mechanical ventilation with pressure limitation and low tidal volumes has become customary in pediatric intensive care units, and this lung protective approach will continue into the foreseeable future. Further investigation is warranted regarding use of high frequency oscillatory ventilation, airway pressure release ventilation, and surfactant to assist pediatric intensivists in application of these therapies.
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Curr Opin Crit Care · Feb 2007
ReviewModulating cofactors of acute lung injury 2005-2006: any closer to 'prime time'?
Considerable progress has recently been made in understanding the modulation of acute lung injury by cofactors that are not traditionally considered 'pulmonary' in nature. We will review findings regarding some of these extrapulmonary cofactors, focusing on those most readily manipulated in the current clinical setting. ⋯ There are a number of simple, low-cost, and rapidly deployable approaches to reducing the severity of acute lung injury that are not directly pulmonary in origin. These interventions could be rapidly implemented in any intensive care unit, once evidence for their efficacy and safety is adequate.