Critical care : the official journal of the Critical Care Forum
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Mechanically ventilated patients with chronic obstructive pulmonary disease often prove challenging to the clinician due to the complex pathophysiology of the disease and the high risk of patient-ventilator asynchrony. These problems are encountered in both intubated patients and those ventilated with noninvasive ventilation. Much knowledge has been gained over the years in our understanding of the mechanisms underlying the difficult interaction between these patients and the machines used to provide them with the ventilatory support they often require for prolonged periods. This paper attempts to summarize the various key issues of patient-ventilator interaction during pressure support ventilation, the most often used partial ventilatory support mode, and to draw clinicians' attention to the need for sufficient knowledge when setting the ventilator at the bedside, given the often conflicting goals that must be met.
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We summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. ⋯ Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies.
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Comparative Study
Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study.
The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. ⋯ NIPPV should be tried very cautiously or not at all in patients with ALI who have shock, metabolic acidosis or profound hypoxemia.
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Cognitive dysfunction is common in critically ill patients, not only during the acute illness but also long after its resolution. A large number of pathophysiologic mechanisms are thought to underlie critical illness-associated cognitive dysfunction, including neuro-transmitter abnormalities and occult diffuse brain injury. ⋯ Although recent therapeutic advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed if we are to understand better the relative contributions of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Randomized Controlled Trial Comparative Study
Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial [ISRCTN88724583].
Some guidelines to prevent ventilator-associated pneumonia (VAP) do not establish a recommendation for the preferential use of either heat and moisture exchangers (HMEs) or heated humidifiers (HHs), while other guidelines clearly advocate the use of HMEs. The aim of this study was to determine the incidence of VAP associated with HHs or HMEs. ⋯ The patients mechanically ventilated during more than 5 days developed a lower incidence of VAP with a heated humidifier than heat and moisture exchanger.