Articles: function.
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Curr Opin Crit Care · Feb 2014
ReviewSpontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome.
This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS). ⋯ Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.
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Anesthesia and analgesia · Feb 2014
Emulsified isoflurane increases convulsive thresholds of lidocaine and produces neural protection after convulsion in rats.
Local anesthetic-induced convulsions remain a concern of anesthesiologists when performing regional anesthesia. Our previous study found that the lidocaine requirement for IV regional anesthesia was reduced with coadministration of emulsified isoflurane. We designed this study to examine whether emulsified isoflurane could increase the convulsive threshold of lidocaine and produce protection after a lidocaine-induced convulsion. ⋯ Emulsified isoflurane increased the convulsive threshold of lidocaine and preserved neurological function in rats experiencing lidocaine-induced convulsions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2014
Review[Update glutamine and antioxidants in critically ill patients].
Critical illness leads to oxidative stress and can induce or exacerbate nutrient deficiencies. This predisposes patients in the intensive care unit to impaired immune function and increased risk of developing infectious complications, organ dysfunction, and therefore worsens clinical outcome. ⋯ The following article summarizes the rationale and provides an update on recent clinical studies with special focus on the use of glutamine and antioxidants in critically ill patients. It further provides recommendations for the clinical use of these substrates in this particular patient population.
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This article reviews the current diagnostic strategies for patients with suspected pulmonary embolism (PE) focusing on the current first choice imaging modality, computed tomographic pulmonary angiography (CTPA). Diagnostic strengths and weaknesses and associated cost-effectiveness of the diagnostic pathways will be discussed. The radiation dose risk of these pathways will be described and techniques to minimize dose will be reviewed. ⋯ Although current cost-effectiveness evaluations have established CT as integral in the PE diagnostic pathway, failure to acknowledge the impact of alternate diagnosis represents a current knowledge gap. The emerging dual energy capacity of current CT scanners offers the potential to evaluate both pulmonary vascular morphology and ventilation perfusion relationships within the lung parenchyma at high spatial resolution. This dual assessment of lung morphology and lung function at low (< 5 millisievert) radiation dose represents a substantial advance in PE imaging.
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Computed tomography (CT) is the core imaging modality for the evaluation of thoracic disorders. With the recently developed dual-energy CT (DECT) technique, the clinical utility of CT in the management of pulmonary diseases can be expanded. The most actively investigated principle of dual energy is material decomposition based on attenuation differences at different energy levels. ⋯ The second major possibility offered by DECT is virtual monochromatic imaging that represents a new option for standard chest CT in daily routine. In this review, imaging principles and clinical applications of dual-energy thoracic CT are described. Knowledge of the applications of DECT may lead to wider use of this technique in the field of respiratory disorders.