Current opinion in critical care
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Pleural effusions (PLEF) occur frequently in mechanically ventilated patients (MVP). There have been improvements in bedside diagnosis, quantification, and drainage techniques. Nevertheless, information on the impact of PLEF on heart-lung performance and pathophysiologic considerations for drainage in MVP is limited. ⋯ PLEF drainage does not always improve oxygenation in MVP with acute respiratory failure. An assessment of chest wall compliance and a lung recruitment maneuver may help predict the response. Procedural complication risks should be considered when choosing the best approach.
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Acute cor pulmonale is a form of acute right heart failure produced by a sudden increase in resistance to blood flow in the pulmonary circulation, which is now rapidly recognized by bedside echocardiography. ⋯ As a general rule, the treatment consists in rapidly reducing resistance to blood flow in the pulmonary circulation, obtained by a specific strategy according to etiology.
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Curr Opin Crit Care · Feb 2009
ReviewMechanical ventilation: epidemiological insights into current practices.
To describe the trends in the results of epidemiological studies of mechanical ventilation. ⋯ The burden of critical illness will likely continue to increase in the future. Evidence from randomized trials appears to have affected the management of mechanical ventilation, but adherence to evidence-based practices may not be ideal.
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The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential adverse effects. ⋯ The use of NMBAs in acute lung injury/ARDS patients is not marginal. Recent studies suggest a beneficial effect of early use of NMBAs on oxygenation and inflammation. The role of NMBAs in the occurrence of ICU-acquired neuromyopathies and lung atelectasis in ARDS patients remains largely questioned. The use of NMBAs in the early phase of ARDS could reinforce the beneficial effects of a lung-protective ventilation. In this context, the effect of NMBAs on the outcome of ARDS patients must be evaluated.
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We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. ⋯ Results of recent clinical trials, widespread use of clinical applications, and technical progress are leading to reevaluation and extension of extracorporeal gas exchange in critically ill patients with respiratory failure of various forms. Further developments may come from low invasive techniques with high efficiency of CO2 removal from low blood flow.