Current opinion in critical care
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Curr Opin Crit Care · Feb 2013
ReviewExtracorporeal membrane oxygenation in adults with acute respiratory distress syndrome.
To evaluate the last 2 years' publications for evidence supporting use of extracorporeal membrane oxygenation (ECMO) for critically ill adults with acute respiratory distress syndrome (ARDS). ⋯ Intensivists may have increased their utilization of ECMO. Credible evidence for mortality benefit of ECMO is lacking. A prospective randomized controlled trial designed to evaluate the efficacy of ECMO for ARDS is overdue.
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Curr Opin Crit Care · Feb 2013
ReviewThe new definition for acute lung injury and acute respiratory distress syndrome: is there room for improvement?
To review the new (Berlin) definition of the acute respiratory distress syndrome (ARDS) and to propose potential improvements. ⋯ The Berlin definition brought improvement and simplification over the previous definitions. The use of data over the first 24 h to reclassify the severity of the disease and the use of compliance to stratify each oxygenation category might further improve the definition.
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Through shared anatomy, pressures, and endothelial connections, the respiratory and cardiovascular systems affect each other in complex but clinically important ways. ⋯ Cardiopulmonary interactions underpin current views of fluid management and mechanical ventilation. Understanding cardiopulmonary interactions and their physiological basis has direct clinical relevance.
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This critical review discusses the key points that would be of practical help for the clinician who applies noninvasive ventilation (NIV) for treatment of patients with acute respiratory failure (ARF). ⋯ The success of NIV in patients with ARF depends on several factors, including the skills of the clinician, selection of patient, choice of interface, selection of ventilation mode and ventilator setting, monitoring, and the motivation of the patient. Recent advances in the understanding of the physiological aspects of using NIV through different interfaces and ventilator settings have led to improve patient-machine interaction, enhancing favorable NIV outcome.
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Management of the difficult airway is associated with significant morbidity and mortality in critically ill patients. An increasing array of advanced airway tools are available, but appropriate selection and application in the ICU remains poorly defined. ⋯ A systematic approach to intubation that emphasizes planning and teamwork can reduce intubation complications. Early use of an EGA or cricothyroidotomy may reduce complications when oxygenation is inadequate. Use of a gum elastic bougie or indirect optical device is also associated with a high rate of intubation success when oxygenation permits.