Current opinion in critical care
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Electrical impedance tomography (EIT) is a useful noninvasive tool for monitoring ventilation finding its way into the clinical setting. The focus of this review is to discuss the balance between the potential for EIT as a clinical monitor accepting a level of uncertainty and the scientific demand for absolute perfection. ⋯ Already now EIT is a useful clinical monitor. Still more work is needed to develop and interpret indices which are simple enough to be used in the clinical setting to guide the clinician towards effective and safe ventilator management.
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Curr Opin Crit Care · Feb 2012
ReviewRole and potentials of low-flow CO(2) removal system in mechanical ventilation.
An analysis of the technological implementation of extracorporeal CO(2) removal (ECCO(2)R) techniques and of its clinical application. A new classification of ECCO(2)R, based on technological aspects, clinical properties and physiological performance, is proposed. ⋯ The future ventilatory management of patients with acute respiratory failure may include a minimally invasive extracorporeal carbon dioxide removal circuit associated with the least amount of ventilatory support (noninvasive in COPD and/or invasive in ARDS) to minimize sedation, prevent ventilator-induced acute lung injury and nosocomial infections. Randomized clinical trials in the pipeline will confirm this fascinating hypothesis.
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Curr Opin Crit Care · Feb 2012
ReviewExtracorporeal membrane oxygenation for respiratory failure in adults.
This article reviews case series and trials that evaluated extracorporeal membrane oxygenation (ECMO) for respiratory failure and describes patient and circuit management in the modern era of ECMO support. ⋯ The latest generation of ECMO systems is more biocompatible, better performing and longer lasting. Although recent studies suggested that veno-venous ECMO might improve the outcomes of patients with ARDS, indications for ECMO use remain uncertain. Future trials of ECMO for severe ARDS should strictly control for standard-of-care mechanical ventilation strategies in the control group and early transportation on ECMO for patients in the intervention arm.
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Ventilator-induced lung injury (VILI) is a ubiquitous iatrogenic clinical problem in critical care. Aside from avoiding large tidal volumes, little progress has been made in identifying effective clinical strategies to minimize this injury. With recent rapid development in bioinformatics and high-throughput molecular technology, the genetic basis of lung injury has been intensively investigated. This review will describe recent insights and potential therapies developed in the field. ⋯ Much relevant information exists for investigators and clinicians interested in VILI. Future research will interlink evolving data to provide a more integrated picture of the molecular mechanisms involved in VILI enabling translation of the most promising candidate therapies.