Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2012
ReviewSpontaneous breathing activity in acute lung injury and acute respiratory distress syndrome.
We aimed at providing the most recent and relevant evidence regarding spontaneous breathing activity during mechanical ventilation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Both clinical and experimental data are depicted. ⋯ In our opinion, spontaneous breathing activity should be avoided in the first 48 h of mechanical ventilation in patients with severe ARDS (PaO2/FIO2 <120 mmHg), but it may be useful in less severe ARDS and ALI. Clearly, further clinical and experimental investigations on the use of different ventilation modes of supported/unsupported spontaneous breathing in ALI/ARDS are needed.
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Curr Opin Anaesthesiol · Apr 2012
ReviewPlace of the colloids in fluid resuscitation of the traumatized patient.
The examination of the recent literature aimed at analysing the most recent data that could affect decisions regarding the use of colloids in trauma resuscitation. ⋯ Recent trauma studies provide ongoing, but not conclusive, evidence of a benefit from colloid resuscitation in trauma.
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To describe the most recent advances and clinical applications of adjunctive techniques in mechanical ventilation, focusing on their overall impact on mortality and their potential indications in critically ill patients. ⋯ Giving the complexity and dynamism of acute lung injury, timing, severity, and pathophysiologic pertinence are mandatory components of decision-making when considering the application of adjunctive measures to support mechanical ventilation.
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Guidelines for weaning from sedation and weaning from ventilator gained increasing interest in recent years. This includes patients with acute respiratory distress syndrome, as well as other mechanically ventilated patients. This review will give an overview of the current literature and practice guidelines in ventilator and sedation weaning. ⋯ The most important conclusion we come to from recent randomized controlled trials is that only using an integrative algorithm for sedation and ventilator weaning can improve survival of ICU patients.