Current opinion in critical care
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Curr Opin Crit Care · Feb 2021
ReviewEmerging cellular and pharmacologic therapies for acute respiratory distress syndrome.
Advances in our understanding of the pathophysiology and biology of ARDS has identified a number of promising cellular and pharmacological therapies. These emerging therapeutics can modulate the immune response, reduce epithelial injury, target endothelial and vascular dysfunction, have anticoagulant effects, and enhance ARDS resolution. ⋯ Mesenchymal stromal cells, steroids, statins, vitamins, anticoagulants, interferons and carbon monoxide have therapeutic promise for ARDS. Identifying ARDS sub-populations most likely to benefit from targeted therapies may facilitate future advances.
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Curr Opin Crit Care · Feb 2021
ReviewNoninvasive ventilation and high-flow nasal oxygen for acute respiratory failure: is less more?
High-flow nasal oxygen and noninvasive ventilation (NIV) are two strategies representing an alternative to standard oxygen in the management of respiratory failure. ⋯ New large-scale clinical trials are needed to compare high-flow nasal oxygen with standard oxygen in patients with de-novo acute respiratory failure to determine the reference treatment. After which, more protective NIV could be assessed among the more severe patients.
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Curr Opin Crit Care · Feb 2021
ReviewMechanical ventilation of the healthy lungs: lessons learned from recent trials.
Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs. ⋯ In patients with healthy lungs, data indicate that low tidal volume but not higher PEEP is beneficial. Thereby, ventilation strategies differ from those in ARDS patients.
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To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19. ⋯ Given the lack of evidence-based specific ventilatory strategies and a large amount of literature showing pathophysiological features similar to non-COVID-19 ARDS, evidence-based lung-protective ventilatory strategies should be pursued in all patients with COVID-19 ARDS.
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To provide an evidence-based approach to improve first pass success in tracheal intubation while maintaining patient safety in the critically ill. ⋯ Recognizing the challenges and using the appropriate interventions to improve first pass tracheal intubation success, while maintaining patient safety are essential during tracheal intubation in critically ill patients. This review will provide recommendations based on the current evidence, various guidelines and expert opinion in the field. Further research will help us better understand the best strategies to improve patient outcomes.