Current opinion in critical care
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Curr Opin Crit Care · Feb 2006
ReviewVentilation in the prone position in patients with acute lung injury/acute respiratory distress syndrome.
To contrast the beneficial effects of the prone position on the lungs and the lack of proven clinical benefits on patient outcome. ⋯ The prone position is not systematically used in hypoxemic patients. Patients who could benefit from prone position sessions are those with the most severe acute respiratory distress syndrome and those with dorsal lung infiltrates. Whether this can be translated into improvement in patient outcome has yet to be tested in clinical trials.
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Curr Opin Crit Care · Feb 2006
ReviewSurfactant therapy in adults with acute lung injury/acute respiratory distress syndrome.
Several phase II and phase III studies have been performed to investigate safety, efficacy and the improvement of survival due to exogenous surfactant instillation in patients with acute lung injury or acute respiratory distress syndrome. In this review we will discuss the most recent of these studies, paying particular attention to differences in the composition of the exogenous surfactant used, the diverse modes of delivery and dose of therapy and the influence of mechanical ventilation. ⋯ The changes in the surfactant system of patients with acute lung injury and acute respiratory distress syndrome form the rationale for the instillation of exogenous surfactant. There is enough evidence to use surfactant instillation for pediatric patients with acute lung injury. Due to the results of the randomized controlled trials performed so far, however, exogenous surfactant is not recommended for routine use in patients with acute lung injury or acute respiratory distress syndrome. In the future, other surfactants with different compositions may show beneficial effects.
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In recent years, research has led to changes in the practice of mechanical ventilation that are associated with improved patient outcome. Unfortunately, many of these recommendations have not been consistently translated to the bedside. Education is an important component of change management, and thus a review of successful education practices, including those that incorporate advances in technology, is timely. ⋯ A coordinated approach to education about mechanical ventilation should be considered to ensure optimal patient care in a wide variety of clinical settings. Further research is necessary to determine the important characteristics inherent in successful education initiatives, particularly those incorporating new technology such as simulation.
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Curr Opin Crit Care · Feb 2006
ReviewDesigning clinical trials in acute lung injury/acute respiratory distress syndrome.
To review the implications of recent literature for clinical trial design in acute lung injury/acute respiratory distress syndrome (ARDS). ⋯ Clinical trial design in acute lung injury/acute respiratory distress syndrome faces many challenges. Although we have learned much from past trials, persistent design dilemmas must be addressed for future trials.