Current opinion in critical care
-
Esophageal pressure measurement well estimates pleural pressure. The interpretation of absolute values is often debated for various reasons, but the changes in pressure measured are considered very accurate provided that a number of precautions are taken. The information provided by these measurements is unique in nature and has an enormous potential to influence management. It allows to study the exact influence of the chest wall and to determine the real lung distending pressure. It is also the only way to quantify respiratory muscle activity and the work of breathing. ⋯ Application of esophageal pressure monitoring is limited by technical issues, the need for background physiological knowledge and the fact that very few studies have assessed a direct influence of this measurement on patients' outcome. The technique is underused in everyday practice.
-
Curr Opin Crit Care · Feb 2014
ReviewCell-based therapies for the acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is a multifaceted lung disease with no current effective therapy. Many clinical trials using conventional pharmacologic therapies have failed, suggesting the need to examine alternative approaches. Thus, attention has focused on the therapeutic potential of cell-based therapies for ARDS, with promising results demonstrated in relevant preclinical disease models. We review data concerning the therapeutic promise of cell-based therapies for ARDS. ⋯ Cell-based therapies offer considerable promise for the treatment of ARDS. While MSC-based therapies are being rapidly advanced toward clinical testing, clear therapeutic potential exists for other cell types for ARDS. A greater understanding of current knowledge gaps should further enhance the therapeutic potential of cell-based therapies for ARDS.
-
Curr Opin Crit Care · Feb 2014
ReviewWhat is the future of acute respiratory distress syndrome after the Berlin definition?
To analyze recently published articles in the medical literature that studied distinct aspects of adult patients with acute respiratory distress syndrome (ARDS) after the new Berlin definition introduced in 2012. ⋯ The impact of the Berlin definition of ARDS on the incidence, better treatment stratification and mortality ratio of ARDS is still to be determined.
-
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.
-
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.