Current opinion in critical care
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Curr Opin Crit Care · Feb 2008
ReviewThe chest wall in acute lung injury/acute respiratory distress syndrome.
There has recently been renewed interest in the chest wall during mechanical ventilation, related to lung-protective ventilation strategies, as well as in the role of abdominal pressure in many facets of critical illness. The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome. ⋯ As chest wall compliance may have important clinical implications during positive-pressure ventilation, the physiology of this effect should be considered, particularly in patients with acute lung injury and increased abdominal pressure.
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Curr Opin Crit Care · Feb 2008
ReviewAdvances in molecular acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury: the role of genomics, proteomics, bioinformatics and translational biology.
To discuss emerging technologies and their application to translation biology research in the field of acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury. ⋯ Renewed efforts to define the clinical phenotype have coincided with the availability of novel technology that has the potential to address critical molecular aspects of the syndrome. Convergence of these two approaches is expected to bring about a better understanding of acute lung injury and consequently further advances in treatment.
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Curr Opin Crit Care · Feb 2008
ReviewAcute lung injury/acute respiratory distress syndrome pathophysiology: what we have learned from computed tomography scanning.
Although many years have passed since its first application in acute respiratory distress syndrome, computed tomography remains widely employed for research and clinical purposes. Here, we review recent findings derived from computed tomography scanning during acute respiratory distress syndrome, particularly concerning setting positive end-expiratory pressure and mechanisms of ventilator-induced lung injury. ⋯ As far as setting positive end-expiratory pressure is concerned, further randomized clinical studies are warranted to verify the pathophysiologic findings recently observed with computed tomography scanning. Similarly, the safety of the widespread use of low tidal volume should be brought into question, possibly pointing out a category of patients who may benefit from alternative techniques of respiratory support.
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Curr Opin Crit Care · Feb 2008
ReviewDynamic respiratory mechanics in acute lung injury/acute respiratory distress syndrome: research or clinical tool?
Classic static measurements of lung mechanics have been used mainly for research purposes, but have not gained widespread clinical acceptance. Instead, dynamic measurements have been used, but interpretation of results has been hampered by lack of clear definitions. The review provides an overview of possible definitions and a description of methods for evaluating lung mechanics in acute lung injury/acute respiratory distress syndrome patients. ⋯ Functional lung mechanics obtained during ongoing ventilator treatment have the potential to provide information for optimizing ventilator management in critically ill patients.
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Curr Opin Crit Care · Feb 2008
ReviewPeripheral airways injury in acute lung injury/acute respiratory distress syndrome.
Peripheral airways are less than 2 mm in diameter and comprise a relatively large cross-sectional area, which allows for slower, laminar airflow. They include both membranous bronchioles and gas exchange ducts, and have been referred to in the past as the 'quiet zone', partly because these structures were felt to contribute little to lung mechanics, and partly because they are difficult to study directly. ⋯ Understanding the pathophysiology of peripheral airway dysfunction in acute respiratory distress syndrome and mechanical ventilation continues to evolve. Greater insight into the signaling mechanisms involved in cellular injury and repair will lead to further alterations in mechanical ventilation strategies, and may lead to specific treatment options.