Current opinion in critical care
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Curr Opin Crit Care · Feb 2012
ReviewNoninvasive ventilation for the immunocompromised patient: always appropriate?
Over the last few decades, the survival rate in critically ill immunocompromised patients has substantially improved, mainly because of advances in oncohematological treatments and management of organ dysfunctions in the ICU. As a result, the number of patients admitted to the ICU has rapidly grown. Immunocompromised patients in whom acute respiratory failure (ARF) develops often require mechanical ventilatory support. In these patients, noninvasive ventilation (NIV) has the potential of avoiding endotracheal intubation and its complications. This review will discuss the recent findings on the role of NIV in immunocompromised patients with ARF. ⋯ Use of NIV may not be appropriate for all immunocompromised patients. However, current evidence supports the use of NIV as the first-line approach for managing mild/moderate ARF in selected patients with immunosuppression of various origin.
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Curr Opin Crit Care · Feb 2012
ReviewThe role of high-frequency oscillatory ventilation in the treatment of acute respiratory failure in adults.
High-frequency oscillatory ventilation (HFOV) is increasingly used in adults with the acute respiratory distress syndrome (ARDS), who remain hypoxemic during conventional mechanical ventilation. In this review, we will summarize the trials evaluating HFOV in adults with ARDS and discuss issues relevant to the clinician regarding the use of HFOV. ⋯ HFOV theoretically meets the goals of lung-protective ventilation. On the basis of the current evidence, HFOV is associated with improvements in oxygenation in severe, adult ARDS. However, whether HFOV influences mortality, length of ICU stay, ventilator-free days, quality-of-life factors and is cost-effective remains to be determined. Large, prospective, randomized controlled trials such as the ongoing OSCAR and OSCILLATE trials will help further define the role of HFOV in adult ARDS.
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As incidence of acute lung injury (ALI) increases and case fatality decreases, long-term care of survivors is of public health importance. Previous studies demonstrate that these survivors are at risk for impairment in physical, cognitive and mental health. In this review, we will discuss recent studies that add to our knowledge of long-term outcomes after ALI and critical illness. ⋯ Physical, cognitive and mental health impairments after ALI are common, persistent and expensive. Future research is needed to improve prediction, prevention and treatment of these important sequelae.
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Curr Opin Crit Care · Feb 2012
ReviewMeasures to prevent nosocomial infections during mechanical ventilation.
Endotracheal intubation and mechanical ventilation are lifesaving measures in critically ill patients. However, these interventions increase the risk of respiratory infections, particularly ventilator-associated pneumonia (VAP). VAP constitutes a serious burden for the healthcare system and worsens the patient's outcomes; thus, several preventive strategies have been implemented. This communication reviews the current knowledge on VAP pathogenesis and the latest preventive measures. ⋯ There is consistent evidence that strategies affecting the primary mechanisms of VAP pathogenesis efficiently reduce the occurrence of the disease. Preventive measures should be implemented grouped into bundles to improve overall efficacy.
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To describe the physiological meaning and the clinical application of the lung stress and strain concepts. ⋯ End-inspiratory stress and strain, as well as the lung inhomogeneity and the stress raisers, must be taken in account when setting mechanical ventilation.