Current opinion in critical care
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Curr Opin Crit Care · Feb 2011
ReviewPositron emission tomography: a tool for better understanding of ventilator-induced and acute lung injury.
PET has recently gained traction among several groups of investigators as an imaging tool to study lung pathophysiology in vivo noninvasively on a regional basis. This review aims to present the major findings of PET studies on acute lung injury (ALI) and ventilator-induced lung injury (VILI) with a perspective relevant to the physiologist-intensivist. ⋯ PET is a versatile imaging tool for physiologic investigation. By imaging the regional effects of interventions commonly performed in critically ill patients with ALI, PET has improved our understanding of the mechanism by which such interventions can exert their positive or negative effects as well as of the pathophysiology of ALI and VILI.
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Curr Opin Crit Care · Feb 2011
ReviewSedation, delirium and mechanical ventilation: the 'ABCDE' approach.
Delirium and ICU-acquired weakness are frequent in critically ill mechanically ventilated patients. The number of mechanically ventilated patients is increasing, placing more patients at risk for these adverse outcomes. Sedation is given to ensure comfort and to minimize distress, but is linked to delirium and immobility. We review recent findings on the management of mechanically ventilated patients focusing on strategies that may improve neurologic and functional outcomes in critically ill patients. ⋯ Outcomes of critically ill patients can be improved by applying evidence-based therapies for the 'liberation' from mechanical ventilation and sedation, and the 'animation' through early mobilization. Clinicians should be aware of organizational approaches such as the 'ABCDE' bundle to improve the management of mechanically ventilated patients.
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Curr Opin Crit Care · Feb 2011
ReviewH1N1: viral pneumonia as a cause of acute respiratory distress syndrome.
To review the literature on novel swine origin influenza A (H1N1 2009) as a cause of respiratory failure and acute respiratory distress syndrome (ARDS). ⋯ H1N1 2009 has emerged as an important cause of ARDS in 2009-2010. Prompt recognition and treatment with antivirals improves outcomes.
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Curr Opin Crit Care · Feb 2011
ReviewHemodynamic monitoring in the mechanically ventilated patient.
Interactions between the heart and lungs are magnified in patients undergoing mechanical ventilation and the consequences of these interactions always need to be considered when managing ventilated patients. In patients with normal lungs and normal cardiovascular function monitoring needs are minimal, but when oxygenation and cardiac function are compromised careful assessment of the consequences of changes in ventilator settings needs to be considered to ensure that adequate oxygen delivery is maintained. ⋯ Use of simple measurements available during routine monitoring can be very helpful to the informed clinician for optimizing hemodynamic performance as well as patient ventilator interactions.
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Curr Opin Crit Care · Feb 2011
ReviewAcute respiratory distress syndrome, mechanical ventilation, and right ventricular function.
To reiterate the effects of positive pressure ventilation on right ventricular (RV) function in acute respiratory distress syndrome (ARDS), to explain in which conditions acute cor pulmonale (ACP) may worsen prognosis, and to define an approach to protection of the right ventricle. ⋯ Routine RV function assessment leads to an approach to mechanical ventilation in ARDS patients designed for protection of the right ventricle. This approach called 'RV protective approach' must be associated with prone positioning, a method of ventilation that improves RV function.