Current opinion in critical care
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Curr Opin Crit Care · Feb 2017
ReviewHow best to set the ventilator on extracorporeal membrane lung oxygenation.
Extracorporeal respiratory support in patients with acute respiratory distress syndrome is applied either as rescue maneuver for life-threatening hypoxemia or as a tool to reduce the harm of mechanical ventilation. Depending on the blood and gas flow, extracorporeal support may completely substitute the natural lung as a gas exchanger (high-flow venovenous bypass) or reduce the need for mechanical ventilation, enabling the removal of a fraction of the metabolically produced CO2. ⋯ Mechanical ventilation and extracorporeal support are marginally integrated. The best environment for lung healing - complete lung collapse or protective ventilation strategy or fully open and immobile lung (all three conditions feasible with extracorporeal support) - remains to be defined.
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Curr Opin Crit Care · Feb 2017
ReviewLimiting sedation for patients with acute respiratory distress syndrome - time to wake up.
Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. ⋯ Current evidence supports the use of protocol-based, light-sedation strategies in critically ill patients with ARDS. Further research into sedation management specifically in ARDS populations is needed.
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Curr Opin Crit Care · Feb 2017
ReviewAbdominal compartment syndrome and the open abdomen: any unresolved issues?
This article reviews the key principles of abdominal compartment syndrome and the open abdomen, exploring some of the unresolved issues. It reviews new concepts in care. ⋯ The key to optimizing outcome is early abdominal closure within 7 days because failure to do so will increase morbidity, mortality and fistulae formation. Novel techniques complementing existing de-resuscitation techniques are discussed.
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Curr Opin Crit Care · Feb 2017
ReviewExtracorporeal membrane oxygenation: beyond rescue therapy for acute respiratory distress syndrome?
This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. ⋯ As initiation of VV-ECMO allows significant decrease in tidal volume, plateau and driving pressures, which has been associated with improved survival in ARDS patients, new trials should evaluate the impact of its early initiation in patients with severe but not refractory ARDS.
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Curr Opin Crit Care · Feb 2017
ReviewDiagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.
The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. ⋯ Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.