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
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
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
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
ReviewThe endothelium in acute lung injury/acute respiratory distress syndrome.
Since pulmonary edema from increased endothelial permeability is the hallmark of acute lung injury, a frequently encountered entity in critical care medicine, the study of endothelial responses in this setting is crucial to the development of effective endothelial-targeted treatments. ⋯ Mechanistic studies have delivered several interventions, which are effective in preventing and treating experimental acute lung injury and have thus provided objectives for translational studies. Some of these modalities may evolve into clinically useful tools in the treatment of this devastating illness.