Current opinion in critical care
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The incidence of cirrhosis is increasing exponentially and is associated with significant morbidity and mortality. This cirrhotic population is prone to infection, which is a frequent precipitant for the development of organ dysfunction; a syndrome often referred to as 'acute-on-chronic' liver failure. Historically, the perception of cirrhosis with organ dysfunction as having a poor prognosis has led to invariably iniquitous access to intensive care. Data to support this view, however, are lacking. ⋯ Admission to intensive care for many patients with cirrhosis is not futile, particularly for those with single organ dysfunction and acute variceal bleeding. It can be extremely challenging to manage patients with organ dysfunction and encephalopathy in a ward environment, and these patients frequently require, and indeed benefit from, augmented levels of care in high-dependency and intensive care environments.
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Curr Opin Crit Care · Feb 2008
ReviewThe chest wall in acute lung injury/acute respiratory distress syndrome.
There has recently been renewed interest in the chest wall during mechanical ventilation, related to lung-protective ventilation strategies, as well as in the role of abdominal pressure in many facets of critical illness. The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome. ⋯ As chest wall compliance may have important clinical implications during positive-pressure ventilation, the physiology of this effect should be considered, particularly in patients with acute lung injury and increased abdominal pressure.
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Curr Opin Crit Care · Feb 2008
ReviewAdvances in molecular acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury: the role of genomics, proteomics, bioinformatics and translational biology.
To discuss emerging technologies and their application to translation biology research in the field of acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury. ⋯ Renewed efforts to define the clinical phenotype have coincided with the availability of novel technology that has the potential to address critical molecular aspects of the syndrome. Convergence of these two approaches is expected to bring about a better understanding of acute lung injury and consequently further advances in treatment.