Current opinion in critical care
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Curr Opin Crit Care · Feb 2012
ReviewOrgan crosstalk during acute lung injury, acute respiratory distress syndrome, and mechanical ventilation.
Multiple organ failure is the main cause of morbidity and mortality in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) patients. Moreover, survivors of both ALI and ARDS often show significant neurocognitive decline at discharge. These data suggest a deleterious organ crosstalk between lungs and distal organs. This article reviews the recent literature concerning the role of this organ crosstalk during ALI, ARDS, and mechanical ventilation, especially focusing on brain-lung communication. ⋯ Organ crosstalk is an emerging area of research in lung disease in critically ill patients. The findings of these studies are clinically relevant and show the importance of an integrative approach in the management of critical patients. However, further studies are necessary to understand the complex interactions concurring in these pathologies.
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New developments in mechanical ventilation have focused on increasing the patient's control of the ventilator by implementing information on lung mechanics and respiratory drive. Effort-adapted modes of assisted breathing are presented and their potential advantages are discussed. ⋯ Within recent years, a major step forward in the evolution of assisted (effort-adapted) modes of mechanical ventilation was accomplished. There is growing evidence that supports the physiological concept of closed-loop effort-adapted assisted modes of mechanical ventilation. However, at present, the translation into a clear outcome benefit remains to be proven. In order to fill the knowledge gap that impedes the broader application, larger randomized controlled trials are urgently needed. However, with clearly proven drawbacks of conventional assisted modes such as pressure support ventilation, it is probably about time to leave these modes introduced decades ago behind.
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Curr Opin Crit Care · Feb 2012
ReviewImaging in acute lung injury and acute respiratory distress syndrome.
The review focuses on recent achievements obtained by means of imaging techniques in clinical and experimental studies on acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). ⋯ Major improvements were recently obtained in imaging structure and several functions of the lungs, with the potential of positively impacting the clinical practice.
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Successful renal recovery is a key goal of patient management during acute kidney injury in critically ill patients. However, limited information exists to guide clinicians as to what interventions might either decrease or increase the likelihood of renal recovery and especially renal recovery to dialysis independence. The purpose of this review is to analyse recent data and help clinicians with relevant therapeutic choices. ⋯ Available evidence from randomized controlled trials and comparative analysis of their results as well as data from large observational studies suggest that the avoidance of IHD and of a positive fluid balance are likely to increase the speed of renal recovery and may prevent end-stage renal failure in selected high-risk patients with acute kidney injury.
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Curr Opin Crit Care · Dec 2011
Beyond focused assessment with sonography for trauma: ultrasound creep in the trauma resuscitation area and beyond.
The use of ultrasound for the management of the injured patient has expanded dramatically in the last decade. The focused assessment with sonography for trauma (FAST) has become one of the fundamental skills incorporated into the initial evaluation of the trauma patient. However, there are significant limitations of this diagnostic modality as initially described. Novel ultrasound examinations of the injured patient, although useful, must also be considered carefully. ⋯ The indications for FAST and additional ultrasound studies in the injured patient continue to evolve. Application of sound clinical evidence will avoid unsubstantiated indications for ultrasound to creep into our clinical practice.