American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2017
Multicenter Study Comparative StudyComparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients.
Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts. ⋯ ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.
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Am. J. Respir. Crit. Care Med. · Apr 2017
ReviewSpontaneous Breathing During Mechanical Ventilation - Risks, Mechanisms & Management.
Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation, and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized, and thus spontaneous breathing may confer additional advantage. ⋯ Notwithstanding the central place of spontaneous breathing in mechanical ventilation, accumulating evidence indicates that it may cause-or worsen-acute lung injury, especially if acute respiratory distress syndrome is severe and spontaneous effort is vigorous. This Perspective reviews the evidence for this phenomenon, explores mechanisms of injury, and provides suggestions for clinical management and future research.