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
ReviewUpdate of early respiratory failure in the lung transplant recipient.
Respiratory failure remains the most common complication in the perioperative period after lung transplantation. Consequently it is important to develop an approach to diagnosis and the treatment of respiratory failure in this population. This review highlights the advances made in the understanding and treatment of lung transplant patients in the early postoperative phase. Owing to its relative importance, advances in the understanding and treatment of ischaemia-reperfusion injury are highlighted. ⋯ Many advances have been made in the understanding of ischaemia-reperfusion injury. Owing to the acute and long-term implications of this complication, interventions that reduce the risk of developing ischaemia-reperfusion need to be evaluated in prospective 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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Curr Opin Crit Care · Feb 2006
ReviewFebrile respiratory illness in the intensive care unit setting: an infection control perspective.
We have examined studies published since the severe acute respiratory syndrome outbreak that elucidate the mode of transmission of respiratory pathogens and the optimal means of interrupting their transmission, focusing on transmission in the intensive care unit. ⋯ Most respiratory pathogens can be transmitted by more than one route. Despite this, healthcare worker awareness of clinical syndromes associated with respiratory pathogens that require airborne precautions, combined with the use of standard precautions for all patients, and contact/droplet precautions for patients with undifferentiated febrile respiratory illness should be effective in interrupting the transmission of respiratory pathogens within the intensive care unit.
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Curr Opin Crit Care · Feb 2006
ReviewDeveloping and managing a team to participate in trials involving acute respiratory failure: advice for the inexperienced.
Conducting large-scale clinical trials in the field of acute respiratory failure requires substantial collaboration. Teamwork is still in its infancy within the realm of clinical research. This review evaluates the need for and grassroots process of teamwork and considers the challenges facing teamwork in the specific context of conducting acute respiratory failure research today. ⋯ As large-scale (oftentimes international) multicenter trials are increasingly providing answers to our research questions, greater emphasis must be placed on team building within the clinical research environment. An urgent need for further work in this area is revealed. Critical care fellowships should integrate teamwork skills into the curriculum.