Current opinion in critical care
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Curr Opin Crit Care · Feb 2008
ReviewPulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality?
The pathogenesis of acute respiratory distress syndrome has been explained by the presence of a direct (pulmonary) or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of acute respiratory distress syndrome may differ according to the type of the insult. This article presents a brief overview of the differences between pulmonary and extrapulmonary acute respiratory distress syndrome, and discusses the interactions between lung functional, morphological aspects, and response to different therapies, both in experimental models and in patients with acute respiratory distress syndrome. ⋯ Heterogeneous acute respiratory distress syndrome patients are still considered to suffer from one syndrome, and are treated in the same way. Understanding the range of different pathways that lead to pulmonary dysfunction makes it possible to better target clinical treatment.
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Curr Opin Crit Care · Feb 2008
ReviewAcute lung injury/acute respiratory distress syndrome pathophysiology: what we have learned from computed tomography scanning.
Although many years have passed since its first application in acute respiratory distress syndrome, computed tomography remains widely employed for research and clinical purposes. Here, we review recent findings derived from computed tomography scanning during acute respiratory distress syndrome, particularly concerning setting positive end-expiratory pressure and mechanisms of ventilator-induced lung injury. ⋯ As far as setting positive end-expiratory pressure is concerned, further randomized clinical studies are warranted to verify the pathophysiologic findings recently observed with computed tomography scanning. Similarly, the safety of the widespread use of low tidal volume should be brought into question, possibly pointing out a category of patients who may benefit from alternative techniques of respiratory support.
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Curr Opin Crit Care · Feb 2008
ReviewStatic pressure-volume curves of the respiratory system: were they just a passing fad?
The aim of this article is to describe the physiologic utility, correlation with lung morphology, difficulties in interpretation and current clinical applications of static respiratory system pressure-volume curves at the bedside in patients with acute lung injury or acute respiratory distress syndrome. ⋯ The physiologic data obtained by measuring the static pressure-volume curves have helped clinicians to better understand the behavior of the respiratory system when positive-pressure ventilation is applied. The advanced technology incorporated into modern ventilators allows routine measurement of pressure-volume curves under sedation without paralysis, with acceptable variability and no serious adverse effects.
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Curr Opin Crit Care · Feb 2008
ReviewAdvances in molecular acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury: the role of genomics, proteomics, bioinformatics and translational biology.
To discuss emerging technologies and their application to translation biology research in the field of acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury. ⋯ Renewed efforts to define the clinical phenotype have coincided with the availability of novel technology that has the potential to address critical molecular aspects of the syndrome. Convergence of these two approaches is expected to bring about a better understanding of acute lung injury and consequently further advances in treatment.