ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Lung volume recruitment, referring to the reopening of closed lung units, forms a cornerstone to some of the recently emphasized ventilatory strategies in early acute respiratory distress syndrome. Although positive end-respiratory pressure is the most commonly used method to achieve lung volume recruitment, considerable controversy exists on how to establish its optimal level. Other recruitment techniques that are either in early clinical usage or on the horizon include: intermittent inflation to total lung capacity, prone positioning, partial liquid ventilation, volume recruitment maneuvers, and high-frequency oscillation. This article presents a discussion of each of these techniques and reviews relevant studies evaluating each modality, highlighting new developoments.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Extensive efforts are made to achieve arterial oxygenation goals by complex ventilatory strategies and nonconventional interventions. These oxygenation goals are based on an emperic, and clearly limited, understanding of oxygen dynamics is critically ill patients. Several studies indicate that our assumptions and accepted practice in this area need radical reappraisal. Supportive therapy to increase PaO2for patients with acute respiratory distress syndrome involves supplemental inspired oxygen and mechanical ventilation. Both of these modalities may be inherently harmful, and studies are required to provide evidence based rationale for use of optimal PaO2goals.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The acute respiratory distress syndrome (ARDS) is a disease defined by specific criteria of respiratory failure but caused by a variety of different insults. When designing exogenous surfactant treatment strategies for patients with ARDS, it is important first to characterize the lung injury and to optimize several factors that can influence the host's response to this therapy. For example, in patients with established ARDS, large doses of a biophysically active surfactant delivered via instillation would be suitable. However, in patients with mild lung injury at risk of developing ARDS, a lower dose of a surfactant with anti-inflammatory properties delivered via aerosol may be optimal. If mechanical ventilation is required, using low tidal volume strategies with optimal positive end-respiratory pressure levels is suggested. We conclude that surfactant treatment strategies for ARDS should be tailored to the individual patient.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Mechanical ventilation is a supportive, not curative, form of therapy. The role of mechanical ventilation in the treatment of acute respiratory distress syndrome is considered to be one of the most important aspects of supportive care in these patients. However, in many ways mechanical ventilation is a nonphysiologic process. By using different modes of ventilation, the clinician is often applying levels of pressure, patterns of pressure, tidal volume, ventilatory rate, and concentration of inspired oxygen well beyond the levels that normal lungs usually experience. In this article, I review the current knowledge of innovative ways to maintain or improve arterial oxygenation and ventilation without inflicting further damage to the injured lung.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Respiratory issues are one of the most frequent reasons critical care physicians become involved in the treatment of patients suffering thermal injury. Such patients are subject to asphyxiation, toxic gas exposure, airway swelling, pneumonia, atelectasis, and the acute respiratory distress syndrome. These complications impact on patient mortality. This review focuses on current opinion in regard to these issues, with a particular focus on the timing, diagnosis, and therapy for inhalational injury, pneumonia, and acute respiratory distress syndrome.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Elevations in pulmonary pressure occur in a variety of pulmonary and cardiac diseases. In the newborn period or following heart transplantation, pulmonary hypertension can be sever and devastating. The relative importance of pulmonary hypertension is acute respiratory distress syndrome is unclear. Intravenous vasodilators have been used to reduce pulmonary pressures; however, their use is limited by systemic effects. Owing to their short half-life and mode of administration, inhaled nitric oxide and prostacyclin (at low concentrations) appear to act locally on the pulmonary circulation. To date, the only proven indication for inhaled nitric oxide is in the newborn period to treat pulmonary hypertension and hypoxemia.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Triggering refers to the signal that causes inspiration. A ventilator breath may be time triggered or patient triggered. During patient-triggered breaths, the ventilator may detect patient effort using a variety of inputs. These include pressure, volume, flow, impedance, and motion. Ventilator operation during patient-triggered breaths varies with the trigger variable and the type of ventilator. Clinicians should understand ventilator operation during patient-triggered modes in order to maximize patient-ventilator synchrony.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The best approach to wean patients most rapidly from ventilatory support has been debated for years. Most recently, randomized, prospective trials comparing protocolized approaches to weaning have been compared with standard physician ordering practices. These studies indicate more rapid weaning with protocols, shorter intensive care unit stays, and mechanical ventilation times as well as cost savings without increased complication rates. A well-defined, consistently applied approach, managed by respiratory therapists and nurses, appears to be the most efficient method of weaning patients from ventilatory support.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Respiratory failure is a recognized complicationm of both bone marrow and solid-organ transplant. Patients who require mechanical ventilation after bone marrow transplant have a high mortality. Recent studies have focused on 1) describing clinical scenarios likely to result in respiratory failure, 2) assessing potential predictors of respiratory failure, and 3) evaluating diagnostic approaches. Solid-organ transplant recipients are moist likely to develop respiratory failure secondary to infectious complications. Aggressive prophylaxis has greatly improved the outlook in many cases; however, emerging organisms, particularly fungal organisms, remain a significant threat. Lung transplants are particularly susceptible to early reperfusion injury and late obliterative bronchiolitis. Extracorporeal membrane oxygenation has been successfully used to support patients with severe reperfusion injury. Obliterative bronchiolitis is a more difficult problem that is still being completely characterized and that has responded only modestly to treatment attempts.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID