Current opinion in critical care
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In intubated patients, mechanical ventilation offers essential ventilatory support, while the respiratory system recovers from acute respiratory failure. Yet, invasive mechanical ventilation is associated with risks and complications that prolong the duration of mechanical ventilation and increase the risk for death. Therefore, safely weaning the patient from the ventilator as soon as possible is paramount. Recent randomized trials have addressed a number of key areas of interest. ⋯ Weaning from mechanical ventilation continues to be an area of considerable importance. Recent randomized controlled trials provide high-level evidence for the best approaches to weaning and extubation.
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We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. ⋯ Results of recent clinical trials, widespread use of clinical applications, and technical progress are leading to reevaluation and extension of extracorporeal gas exchange in critically ill patients with respiratory failure of various forms. Further developments may come from low invasive techniques with high efficiency of CO2 removal from low blood flow.
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Sleep distortion has been studied as an independent risk factor for morbidity and mortality; however, this role in the ICU patients is unclear. These patients suffer from psychological and physiological stressors and significant disturbance in sleep. We conducted a systematic review of all recent data over the last decade to elaborate the extent and implications of sleep disruption in the ICU. ⋯ This article discusses the available data on sleep disruption in patients in the ICU and implications with discussion of effects of ventilators and commonly used medications in the ICU. We will conclude with interventions to improve sleep in the intensive care setting.
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Electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring tool that allows real-time imaging of ventilation. The purpose of this article is to discuss the fundamentals of EIT and to review the use of EIT in critical care patients. ⋯ EIT is cheap, noninvasive and allows continuous monitoring of ventilation. It is gaining acceptance as a valuable monitoring tool for the care of critical patients.
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Although drug therapy is most commonly delivered via the intravenous route, novel inhaled agents have been introduced for use in the ICU. Additionally, drugs previously delivered intravenously are now being delivered via the respiratory tract in an effort to reduce systemic toxicity and maximize effectiveness. ⋯ Inhaled nitric oxide has an established role in neonatal intensive care and a limited role in adult intensive care. Heliox provides symptom relief, but at present cannot be considered routine as a consequence of the multiple technological challenges. Inhaled antimicrobials appear to provide a therapeutic advantage in select individuals with pneumonia. Secretion management is best achieved by adequate humidification and as needed suctioning. The role of inhaled carbon monoxide in critical care holds significant promise, but is currently in early clinical trials.