Current opinion in critical care
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The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries' healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons. ⋯ A targeted improvement of hospital and ICU protocols will increase medical care quality for patients admitted to the hospital for any clinical reasons during a pandemic.
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Ventilator weaning forms an integral part in critical care medicine and strategies to shorten duration are rapidly evolving alongside our knowledge of the relevant physiological processes. The purpose of the current review is to discuss new physiological and clinical insights in ventilator weaning that help us to fasten liberation from mechanical ventilation. ⋯ A thorough understanding of the physiological adaptations during withdrawal of positive pressure ventilation is extremely important for clinicians in the ICU. We summarize and discuss novel insights in this field.
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Curr Opin Crit Care · Feb 2021
ReviewBedside noninvasive monitoring of mechanically ventilated patients.
Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients. ⋯ Bedside techniques - such as EIT and PoCUS - are becoming standards of the care for mechanically ventilated patients to monitor the changes in lung aeration, ventilation and perfusion in response to treatment and to assess weaning from mechanical ventilation.
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A growing evidence shows that injurious spontaneous breathing, either too weak or too strong, may injure lung and diaphragm. The purpose of review is to understand why we need monitoring for safe spontaneous breathing, and to know the target value of each monitoring to preserve safe spontaneous breathing during assisted ventilation. ⋯ We summarize why we need monitoring for safe spontaneous breathing during assisted ventilation and what the target value of each monitoring is to facilitate 'safe' spontaneous breathing during assisted ventilation.
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This article provides an overview of protein biomarkers for acute respiratory distress syndrome (ARDS) and their potential use in future clinical trials. ⋯ This article summarizes the current research on ARDS biomarkers and provides insights into how they should be integrated as prognostic and predictive enrichment tools in future clinical trials.