Current opinion in critical care
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Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk. ⋯ Gastrointestinal motility disturbances are caused by a myriad of pathological processes. Moreover, bowel integrity is governed by comorbidity, impaired metabolic function and pharmacological interventions in critically ill patients. Restoring gastrointestinal function, therefore, requires a multimodal approach including prophylactic management strategies and the sensible use of substances with inhibitory effects on intestinal motility.
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Curr Opin Crit Care · Apr 2010
The effects of mechanical ventilation on hepato-splanchnic perfusion.
Mechanical ventilation is a cornerstone of ICU treatment. Because of its interaction with blood flow and intra-abdominal pressure, mechanical ventilation has the potential to alter hepato-splanchnic perfusion, abdominal organ function and thereby outcome of the most critically ill patients. ⋯ Mechanical ventilation and attempts to improve oxygenation such as intratracheal suctioning and recruitment maneuvers, may have harmful consequences in patients with already limited cardiovascular reserves or deteriorated intestinal perfusion. Due to difficulties in assessing hepato-splanchnic perfusion, such effects are often not detected.
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Allocation of grafts for lung transplantation has been directed in many countries to patients in life-threatening conditions. Advances in technology for extracorporeal devices led to new concepts and increased use for bridging to lung transplantation. Taking these two developments into account, it seems that bridging technologies are used more frequently around the world. ⋯ Bridge to lung transplantation is of increasing importance with new allocation systems and the increasing demand. New extracorporeal technologies address this demand with reliable function for some weeks. But these developments also raise ethical questions of how to use these new tools wisely individually and also collectively for the field of lung transplantation.
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Curr Opin Crit Care · Feb 2010
ReviewPharmacological treatments for acute respiratory distress syndrome.
Studies of the pharmacologic management of acute respiratory distress syndrome (ARDS) have yielded conflicting results. The purpose of this review is to discuss recent pharmacologic trials in ARDS, using the conceptual framework of ARDS as a heterogeneous disease. ⋯ ARDS is a heterogeneous syndrome. Failure to target subgroups more likely to benefit from specific therapies may be one explanation for largely disappointing trial results so far.