Current opinion in critical care
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Curr Opin Crit Care · Feb 2008
ReviewThe chest wall in acute lung injury/acute respiratory distress syndrome.
There has recently been renewed interest in the chest wall during mechanical ventilation, related to lung-protective ventilation strategies, as well as in the role of abdominal pressure in many facets of critical illness. The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome. ⋯ As chest wall compliance may have important clinical implications during positive-pressure ventilation, the physiology of this effect should be considered, particularly in patients with acute lung injury and increased abdominal pressure.
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Curr Opin Crit Care · Feb 2008
ReviewDynamic respiratory mechanics in acute lung injury/acute respiratory distress syndrome: research or clinical tool?
Classic static measurements of lung mechanics have been used mainly for research purposes, but have not gained widespread clinical acceptance. Instead, dynamic measurements have been used, but interpretation of results has been hampered by lack of clear definitions. The review provides an overview of possible definitions and a description of methods for evaluating lung mechanics in acute lung injury/acute respiratory distress syndrome patients. ⋯ Functional lung mechanics obtained during ongoing ventilator treatment have the potential to provide information for optimizing ventilator management in critically ill patients.
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Curr Opin Crit Care · Feb 2008
ReviewPeripheral airways injury in acute lung injury/acute respiratory distress syndrome.
Peripheral airways are less than 2 mm in diameter and comprise a relatively large cross-sectional area, which allows for slower, laminar airflow. They include both membranous bronchioles and gas exchange ducts, and have been referred to in the past as the 'quiet zone', partly because these structures were felt to contribute little to lung mechanics, and partly because they are difficult to study directly. ⋯ Understanding the pathophysiology of peripheral airway dysfunction in acute respiratory distress syndrome and mechanical ventilation continues to evolve. Greater insight into the signaling mechanisms involved in cellular injury and repair will lead to further alterations in mechanical ventilation strategies, and may lead to specific treatment options.
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Curr Opin Crit Care · Feb 2008
ReviewLung ultrasound in acute respiratory distress syndrome and acute lung injury.
Lung ultrasound at the bedside can provide accurate information on lung status in critically ill patients with acute respiratory distress syndrome. ⋯ Lung ultrasound is noninvasive, easily repeatable and allows assessment of changes in lung aeration induced by the various therapies. It is among the most promising bedside techniques for monitoring patients with acute respiratory distress syndrome.
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Curr Opin Crit Care · Feb 2008
ReviewExtracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma?
The extracellular matrix plays an important role in the biomechanical behaviour of the lung parenchyma. The matrix is composed of a three-dimensional fibre mesh filled with different macromolecules, including proteoglycans which have important functions in many lung pathophysiological processes, as they regulate tissue hydration, macromolecular structure and function, response to inflammatory agents, and tissue repair and remodelling. The aim of this review is to describe the role of mechanical ventilation on pulmonary extracellular matrix structure and function. ⋯ Tidal volume reduction to 6 ml/kg may be useful during mechanical ventilation of healthy lungs. The study of the extracellular matrix may be useful to better understand the pathophysiology of ventilator-induced lung injury in healthy and diseased lungs.