Current opinion in critical care
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In recent years, research has led to changes in the practice of mechanical ventilation that are associated with improved patient outcome. Unfortunately, many of these recommendations have not been consistently translated to the bedside. Education is an important component of change management, and thus a review of successful education practices, including those that incorporate advances in technology, is timely. ⋯ A coordinated approach to education about mechanical ventilation should be considered to ensure optimal patient care in a wide variety of clinical settings. Further research is necessary to determine the important characteristics inherent in successful education initiatives, particularly those incorporating new technology such as simulation.
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Concepts of ventilator-induced lung injury have revolutionized our approach to the ventilatory management of patients with acute lung injury and acute respiratory distress syndrome over the past 10 years. The extension of these principles to patients with brain injuries is challenging, as many of them are out of keeping with usual brain-protective management. ⋯ In many patients with brain injuries and acute lung injury the goals of lung protection can be achieved without threatening cerebral perfusion. In patients with more refractory raised intracranial pressure the optimal balance between brain and lung is not well established. Further research is needed on lung-protective strategies in this vulnerable population.
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Curr Opin Crit Care · Feb 2006
ReviewThe support of severe respiratory failure beyond the hospital and during transportation.
Given the number and variety of calamities in the past few years, providing support for critically ill and injured casualties has become a global priority. This article reviews and describes the challenges faced in providing critical care and respiratory support in an austere environment and during medical transport. The primary focus to be discussed is mechanical ventilation. ⋯ The support of respiratory failure with mechanical ventilation during a disaster is complex and challenging. The key to success is pre-planning, flexibility, and portability. Programmes such as the Critical Care Aeromedical Transport Teams can be a useful model for the development of appropriate civil response capabilities in critical care for use during a disaster.
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Curr Opin Crit Care · Feb 2006
ReviewFebrile respiratory illness in the intensive care unit setting: an infection control perspective.
We have examined studies published since the severe acute respiratory syndrome outbreak that elucidate the mode of transmission of respiratory pathogens and the optimal means of interrupting their transmission, focusing on transmission in the intensive care unit. ⋯ Most respiratory pathogens can be transmitted by more than one route. Despite this, healthcare worker awareness of clinical syndromes associated with respiratory pathogens that require airborne precautions, combined with the use of standard precautions for all patients, and contact/droplet precautions for patients with undifferentiated febrile respiratory illness should be effective in interrupting the transmission of respiratory pathogens within the intensive care unit.
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Curr Opin Crit Care · Feb 2006
ReviewDeveloping and managing a team to participate in trials involving acute respiratory failure: advice for the inexperienced.
Conducting large-scale clinical trials in the field of acute respiratory failure requires substantial collaboration. Teamwork is still in its infancy within the realm of clinical research. This review evaluates the need for and grassroots process of teamwork and considers the challenges facing teamwork in the specific context of conducting acute respiratory failure research today. ⋯ As large-scale (oftentimes international) multicenter trials are increasingly providing answers to our research questions, greater emphasis must be placed on team building within the clinical research environment. An urgent need for further work in this area is revealed. Critical care fellowships should integrate teamwork skills into the curriculum.