Current opinion in critical care
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Curr Opin Crit Care · Feb 2009
ReviewMechanical ventilation: epidemiological insights into current practices.
To describe the trends in the results of epidemiological studies of mechanical ventilation. ⋯ The burden of critical illness will likely continue to increase in the future. Evidence from randomized trials appears to have affected the management of mechanical ventilation, but adherence to evidence-based practices may not be ideal.
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We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. ⋯ Results of recent clinical trials, widespread use of clinical applications, and technical progress are leading to reevaluation and extension of extracorporeal gas exchange in critically ill patients with respiratory failure of various forms. Further developments may come from low invasive techniques with high efficiency of CO2 removal from low blood flow.
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The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential adverse effects. ⋯ The use of NMBAs in acute lung injury/ARDS patients is not marginal. Recent studies suggest a beneficial effect of early use of NMBAs on oxygenation and inflammation. The role of NMBAs in the occurrence of ICU-acquired neuromyopathies and lung atelectasis in ARDS patients remains largely questioned. The use of NMBAs in the early phase of ARDS could reinforce the beneficial effects of a lung-protective ventilation. In this context, the effect of NMBAs on the outcome of ARDS patients must be evaluated.
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Sleep distortion has been studied as an independent risk factor for morbidity and mortality; however, this role in the ICU patients is unclear. These patients suffer from psychological and physiological stressors and significant disturbance in sleep. We conducted a systematic review of all recent data over the last decade to elaborate the extent and implications of sleep disruption in the ICU. ⋯ This article discusses the available data on sleep disruption in patients in the ICU and implications with discussion of effects of ventilators and commonly used medications in the ICU. We will conclude with interventions to improve sleep in the intensive care setting.
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Electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring tool that allows real-time imaging of ventilation. The purpose of this article is to discuss the fundamentals of EIT and to review the use of EIT in critical care patients. ⋯ EIT is cheap, noninvasive and allows continuous monitoring of ventilation. It is gaining acceptance as a valuable monitoring tool for the care of critical patients.