American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jun 2017
ReviewEarly Lung Disease in Infants and Pre-school Children with Cystic Fibrosis: What Have We Learnt and What Should We Do About It?
The past decade has seen significant advances in understanding of the pathogenesis and progression of lung disease in cystic fibrosis (CF). Pulmonary inflammation, infection, and structural lung damage manifest very early in life and are prevalent among preschool children and infants, often in the absence of symptoms or signs. Early childhood represents a pivotal period amenable to intervention strategies that could delay or prevent the onset of lung damage and alter the longer-term clinical trajectory for individuals with CF. This review summarizes what we have learned about early lung disease in children with CF and discusses the implications for future clinical practice and research.
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Am. J. Respir. Crit. Care Med. · Jun 2017
Meta AnalysisEffort To Breathe With Various Spontaneous Breathing Trial Techniques. A Physiological Meta-analysis.
Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. ⋯ Pressure support reduces respiratory effort compared with T-piece. Continuous positive airway pressure of 0 cm H2O and T-piece more accurately reflect the physiologic conditions after extubation.
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Am. J. Respir. Crit. Care Med. · Jun 2017
ReviewFifty Years of Research in ARDS. Setting Positive End-expiratory Pressure in the Acute Respiratory Distress Syndrome.
Positive end-expiratory pressure (PEEP) has been used during mechanical ventilation since the first description of acute respiratory distress syndrome (ARDS). In the subsequent decades, many different strategies for optimally titrating PEEP have been proposed. Higher PEEP can improve arterial oxygenation, reduce tidal lung stress and strain, and promote more homogenous ventilation by preventing alveolar collapse at end expiration. ⋯ Other methods set PEEP based on mechanical parameters, such as the plateau pressure, respiratory system compliance, or transpulmonary pressure. No single method of PEEP titration has been shown to improve clinical outcomes compared with other approaches of setting PEEP. Future trials should focus on identifying individuals who respond to higher PEEP with recruitment and on clinically important outcomes (e.g., mortality).