Current opinion in critical care
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Curr Opin Crit Care · Feb 2008
ReviewLung ultrasound in acute respiratory distress syndrome and acute lung injury.
Lung ultrasound at the bedside can provide accurate information on lung status in critically ill patients with acute respiratory distress syndrome. ⋯ Lung ultrasound is noninvasive, easily repeatable and allows assessment of changes in lung aeration induced by the various therapies. It is among the most promising bedside techniques for monitoring patients with acute respiratory distress syndrome.
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Curr Opin Crit Care · Feb 2008
ReviewPulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality?
The pathogenesis of acute respiratory distress syndrome has been explained by the presence of a direct (pulmonary) or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of acute respiratory distress syndrome may differ according to the type of the insult. This article presents a brief overview of the differences between pulmonary and extrapulmonary acute respiratory distress syndrome, and discusses the interactions between lung functional, morphological aspects, and response to different therapies, both in experimental models and in patients with acute respiratory distress syndrome. ⋯ Heterogeneous acute respiratory distress syndrome patients are still considered to suffer from one syndrome, and are treated in the same way. Understanding the range of different pathways that lead to pulmonary dysfunction makes it possible to better target clinical treatment.
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Curr Opin Crit Care · Feb 2008
ReviewStatic pressure-volume curves of the respiratory system: were they just a passing fad?
The aim of this article is to describe the physiologic utility, correlation with lung morphology, difficulties in interpretation and current clinical applications of static respiratory system pressure-volume curves at the bedside in patients with acute lung injury or acute respiratory distress syndrome. ⋯ The physiologic data obtained by measuring the static pressure-volume curves have helped clinicians to better understand the behavior of the respiratory system when positive-pressure ventilation is applied. The advanced technology incorporated into modern ventilators allows routine measurement of pressure-volume curves under sedation without paralysis, with acceptable variability and no serious adverse effects.
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Curr Opin Crit Care · Feb 2008
ReviewExtracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma?
The extracellular matrix plays an important role in the biomechanical behaviour of the lung parenchyma. The matrix is composed of a three-dimensional fibre mesh filled with different macromolecules, including proteoglycans which have important functions in many lung pathophysiological processes, as they regulate tissue hydration, macromolecular structure and function, response to inflammatory agents, and tissue repair and remodelling. The aim of this review is to describe the role of mechanical ventilation on pulmonary extracellular matrix structure and function. ⋯ Tidal volume reduction to 6 ml/kg may be useful during mechanical ventilation of healthy lungs. The study of the extracellular matrix may be useful to better understand the pathophysiology of ventilator-induced lung injury in healthy and diseased lungs.
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Curr Opin Crit Care · Feb 2008
ReviewDo airway secretions play an underappreciated role in acute respiratory distress syndrome?
We review the evidence that airway secretions may have an underappreciated role in acute respiratory distress syndrome, contributing to physiologic disarrangements, ventilator dependence and perhaps to injury generation. As common manipulations of ventilator settings, position and fluid status have the potential to influence these problems, explorations into the secretion dynamics of acute lung injury may be fertile ground for developing therapeutic advances. ⋯ Capability of ventilation and positioning to mobilize secretions implies the potential for clearance or containment of inflammatory mediators and infection. Ventilatory and positional prescriptions could be designed to meet one of either conflicting targets. Additional experimental and clinical investigations are required before adopting these proposed therapeutic principles into practice.