Current opinion in critical care
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The term permissive hypercapnia defines a ventilatory strategy for acute respiratory failure in which the lungs are ventilated with a low inspiratory volume and pressure. The aim of permissive hypercapnia is to minimize lung damage during mechanical ventilation; its limitation is the resulting hypoventilation and carbon dioxide (CO2) retention. In this article we discuss the rationale, physiologic implications, and implementation of permissive hypercapnia. We then review recent clinical studies that tested the effect of various approaches to permissive hypercapnia on the outcome of patients with acute respiratory failure.
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Partial liquid ventilation (PLV) developed considerably in the clinical and experimental fields during the past few years. In addition to improved oxygenation and lung mechanics by perfluorocarbon (PFC) administration, recent animal studies have tried to optimize PLV by evaluating the most appropriate ventilatory mode to use during PLV and by adjusting the best level of positive end-expiratory pressure (PEEP). ⋯ Although the precise dosing of PFC is debated, evidence from several experimental studies supports the use of smaller doses of PFC because larger doses increase the occurrence of baro- and volutrauma. In the clinical field, after promising data from preliminary studies, an international randomized controlled trial is on the verge of completion.