Current opinion in critical care
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Curr Opin Crit Care · Feb 2017
ReviewExtracorporeal membrane oxygenation: beyond rescue therapy for acute respiratory distress syndrome?
This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. ⋯ As initiation of VV-ECMO allows significant decrease in tidal volume, plateau and driving pressures, which has been associated with improved survival in ARDS patients, new trials should evaluate the impact of its early initiation in patients with severe but not refractory ARDS.
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Curr Opin Crit Care · Feb 2017
ReviewDiagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.
The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. ⋯ Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.
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Curr Opin Crit Care · Feb 2017
ReviewAcute respiratory distress syndrome mimics: the role of lung biopsy.
Acute respiratory distress syndrome (ARDS) mimics is a condition looking like ARDS but that does not fulfill every criterion according to the recent Berlin definition. The purpose of this review is to better delineate ARDS mimics, to discuss why the complete diagnosis of ARDS is important, and to make a brief overview on the role of open lung biopsy in this setting. ⋯ An ARDS mimic enhances the need of making ARDS diagnosis as comprehensive as possible. In some limited cases, open lung biopsy in skilled hands may have implications for management.
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Curr Opin Crit Care · Feb 2017
ReviewLooking closer at acute respiratory distress syndrome: the role of advanced imaging techniques.
Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging. ⋯ Progresses in lung imaging are key to individualize therapy, diagnosis, and pathophysiological mechanism at play in any patient at any specified time, helping to move toward personalized medicine for ARDS.
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Curr Opin Crit Care · Feb 2017
ReviewGOLDEN anniversary of the acute respiratory distress syndrome: still much work to do!
Over the past 50 years, we have developed a conceptual model of the acute respiratory distress syndrome (ARDS), and have witnessed significant advances in the care of patients with ARDS. In this commentary, we will discuss recent published articles reporting or suggesting new conceptual models for diagnosis, classification, stratification, prevention, ventilatory management, pharmacologic treatment, and outcome prediction of ARDS. ⋯ Because this year is the golden anniversary of the first clinical description of ARDS in 1967, we have used the acronym 'G.O.L.D.E.N.' to frame our review. It is clear that although much has been learned over the past 50 years, there is still much work to do to unravel and control this continuously surprising syndrome.