Current opinion in critical care
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Curr Opin Crit Care · Feb 2014
ReviewPostoperative respiratory failure: pathogenesis, prediction, and prevention.
This review discusses our present understanding of postoperative respiratory failure (PRF) pathogenesis, risk factors, and perioperative-risk reduction strategies. ⋯ PRF is a life-threatening event that is challenging for the surgical team. Risk prediction scales based on large population studies are being developed and validated. We need high-quality trials of preventive measures, particularly those related to ventilator use in both high risk and general populations.
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Curr Opin Crit Care · Feb 2014
ReviewExtracorporeal membrane oxygenation in adult patients with acute respiratory distress syndrome.
To examine the role of extracorporeal membrane oxygenation (ECMO) as potential therapeutic option for severe cases of acute respiratory distress syndrome (ARDS). ⋯ Guidelines from the Extracorporeal Life Support Organization still indicate ECMO for acute severe pulmonary failure potentially reversible and unresponsive to conventional management. The new definition of ARDS (Berlin definition) addresses clinicians to the best treatment options in respect of the severity of illness and allocates ECMO as a potential therapeutic option for patients with severe ARDS and a P/F ratio lower than 100 and proposed that the indication of ECMO may be shifted from the treatment of choice for refractory hypoxemia to the treatment of choice to minimize ventilator-induced lung injury.
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The article provides an overview of efforts to identify and validate biomarkers in acute respiratory distress syndrome (ARDS) and a discussion of the challenges confronting researchers in this area. ⋯ This article summarizes the current status of ARDS biomarker research and provides a framework for future investigation.
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Curr Opin Crit Care · Feb 2014
ReviewPharmacological therapies for acute respiratory distress syndrome.
Despite recent advances in the management of patients with acute respiratory distress syndrome (ARDS) by using protective ventilator strategies, the mortality rate of ARDS remains high. The complexity of the pathogenesis and the heterogeneity of coexisting diseases in patients with ARDS require critical care physicians and researchers to search for multiple therapeutic approaches in order to further improve patient outcome. This review article therefore focuses on the recent studies in the field of pharmacological intervention in ARDS. ⋯ Overall, there is no proven pharmacological therapy in ARDS, but some pharmacological interventions were associated with beneficial effects in certain subgroups of patients depending on the cause, underlying diseases, the concurrent supportive therapies and timing. Further clinical trials are warranted to assess multiple outcome measurement of the promising pharmacological interventions in selected patients with ARDS.
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This review discusses the role of chest ultrasound in diagnosis and management of acute respiratory distress syndrome (ARDS) and the most recent technical progresses in this field. ⋯ An ultrasound-integrated approach combining lung ultrasound and echocardiography should be recommended as a suitable technique to manage ARDS during diagnosis, mechanical ventilation setting, and weaning.