Current opinion in critical care
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Curr Opin Crit Care · Feb 2007
ReviewNoninvasive ventilation in patients with hypoxemic acute respiratory failure.
To discuss the recent literature concerning the use of noninvasive ventilation for hypoxemic acute respiratory failure. ⋯ Hypoxemic acute respiratory failure may benefit from noninvasive ventilation or continuous positive airway pressure, but undue prolongation should be avoided. In postextubation respiratory failure there is no evidence for routine use of noninvasive ventilation.
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Curr Opin Crit Care · Feb 2007
ReviewManagement of ventilator-associated pneumonia caused by multiresistant bacteria.
The inappropriate choice of antibiotics (in nearly one third of episodes) is the most important risk factor for death. Traditionally, a narrow-spectrum drug was used first, and the most potent drugs were reserved for subsequent use. ⋯ As ventilator-associated pneumonia increases, empiric therapy should be based on local pathogen etiology and antibiotic resistant patterns. A new approach to consider is to start with a high-dose, broad-spectrum antibiotic and then tailor the individual therapy based on microbiological results and clinical resolution. With the use of broad-spectrum antibiotics available in empiric therapy tailored after reassessment of the patient, there is hope for reducing costs, length of stay and mortality whereas the emergence of resistance will be minimized.
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Curr Opin Crit Care · Feb 2007
ReviewHyperoxia in the intensive care unit: why more is not always better.
Hyperoxic inspired gas is essential for patients with hypoxic respiratory failure; it is also suspected, however, as a contributor to the pathogenesis of acute lung injury. Several recent studies in humans, animals, and cell culture have identified mechanisms by which hyperoxia may exert deleterious effects on critically ill patients. This review identifies relevant new findings regarding hyperoxic lung injury in the context of providing guidance for future clinical studies. ⋯ Although hyperoxia has not been conclusively identified as a clinically important cause of lung injury in humans, animal data strongly implicate it. Reports of interaction effects between hyperoxia and both mechanical ventilation and host defense suggest that clinical studies of hyperoxia must take these variables into account. Accumulating data about how hyperoxia initiates cell death provide guidance for development of both biomarkers to identify hyperoxia-induced injury and pharmacological interventions to limit hyperoxia's adverse effects.