Current opinion in critical care
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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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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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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.
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In intubated patients, mechanical ventilation offers essential ventilatory support, while the respiratory system recovers from acute respiratory failure. Yet, invasive mechanical ventilation is associated with risks and complications that prolong the duration of mechanical ventilation and increase the risk for death. Therefore, safely weaning the patient from the ventilator as soon as possible is paramount. Recent randomized trials have addressed a number of key areas of interest. ⋯ Weaning from mechanical ventilation continues to be an area of considerable importance. Recent randomized controlled trials provide high-level evidence for the best approaches to weaning and extubation.