Current opinion in critical care
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Curr Opin Crit Care · Feb 2014
ReviewLung recruitment in acute respiratory distress syndrome: what is the best strategy?
Supporting patients with acute respiratory distress syndrome (ARDS) using a low tidal volume strategy is a standard practice in the ICU. Recruitment maneuvers can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and optimal method and patient selection for recruitment maneuvers have not been determined. ⋯ As a component of ventilation strategy for patients with ARDS, the use of recruitment maneuvers, especially a stepwise maneuver, in addition to adequate positive end-expiratory pressure and appropriate positioning, is suggested by currently available data. Until their effect on clinical outcomes is further defined, the use of recruitment maneuvers in ARDS and other settings will continue to be guided by individual clinician experience and patient factors.
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Curr Opin Crit Care · Feb 2014
ReviewWhich is the most important strain in the pathogenesis of ventilator-induced lung injury: dynamic or static?
To discuss the relative role of dynamic and static tissue deformation (strain) generated by inflation of tidal volume and application of positive end-expiratory pressure in the pathogenesis of ventilator-induced lung injury. ⋯ Large lung dynamic strain is more harmful than equivalent static strain.