Clinics in chest medicine
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Clinics in chest medicine · Sep 2015
ReviewManagement of Right Heart Failure in the Intensive Care Unit.
Right heart failure is a clinical syndrome of various causes that commonly involves failure of the right ventricle (RV). The hemodynamic hallmark of the syndrome is increasing central venous pressure and worsening cardiac output with a rising RV end-diastolic pressure. When dealing with RV failure, clinicians must assess and optimize the intravascular volume state, support RV contractility, and address any pathologic elevations of afterload so that systemic perfusion is preserved. Despite these measures, there may still be a need to offer rescue interventions to the failing RV in carefully selected patients.
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Clinics in chest medicine · Sep 2015
ReviewIntegration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers.
Clinicians working in the intensive care unit (ICU) confront death and dying daily. ICU care can be inconsistent with a patient's values, preferences, and previously expressed goals of care. ⋯ This article discusses the benefits and barriers to integration of ICU and palliative care services, and a stepwise approach to implementation of palliative care services. Integration of palliative care services into ICU workflow is increasingly seen as essential to providing high-quality, comprehensive critical care.
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Clinics in chest medicine · Sep 2015
ReviewRecent Advances in the Management of the Acute Respiratory Distress Syndrome.
Advances in management of the acute respiratory distress syndrome (ARDS) include the use of volume and pressure-limited ventilation and a fluid conservative strategy. Despite the extensive study of positive end expiratory pressure, consensus regarding the best approach to its application is lacking. ⋯ Alternate modes of ventilation remain unproven. A focus on ARDS risk factor reduction and the development of tools predicting progression to ARDS have the potential to further reduce its incidence.
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Clinics in chest medicine · Sep 2015
ReviewNovel Uses of Extracorporeal Membrane Oxygenation in Adults.
Extracorporeal membrane oxygenation (ECMO) has been available for decades, with its use steadily expanding in the setting of advances in technology. The most common indications for venovenous and venoarterial ECMO remain severe hypoxemic respiratory failure and cardiogenic shock, respectively. Refinements in extracorporeal circuitry and cannulation strategies have led to novel indications for ECMO in cardiopulmonary failure, including pulmonary hypertension, extracorporeal cardiopulmonary resuscitation, and less severe forms of the acute respiratory distress syndrome. There is hope for the development of destination device therapy, which could have significant implications for acute and chronic management of severe respiratory and cardiac disease.