journal
https://read.qxmd.com/read/38085885/the-place-of-positive-end-expiratory-pressure-in-ventilator-induced-lung-injury-generation
#21
REVIEW
Lauren T Thornton, Rebecca L Kummer, John J Marini
PURPOSE OF REVIEW: Describe the rationale for concern and accumulating pathophysiologic evidence regarding the adverse effects of high-level positive end expiratory pressure (PEEP) on excessive mechanical stress and ventilator-induced lung injury (VILI). RECENT FINDINGS: Although the inclusion of PEEP in numerical estimates of mechanical power may be theoretically debated, its potential to increase stress, strain, and mean airway pressure are not. Recent laboratory data in a variety of animal models demonstrate that higher levels of PEEP coupled with additional fluids needed to offset its impediment of hemodynamic function are associated with increased VILI...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085883/setting-positive-end-expiratory-pressure-lung-and-diaphragm-ultrasound
#22
REVIEW
Amne Mousa, Peter Klompmaker, Pieter R Tuinman
PURPOSE OF REVIEW: The purpose of this review is to summarize the role of lung ultrasound and diaphragm ultrasound in guiding ventilator settings with an emphasis on positive end-expiratory pressure (PEEP). Recent advances for using ultrasound to assess the effects of PEEP on the lungs and diaphragm are discussed. RECENT FINDINGS: Lung ultrasound can accurately diagnose the cause of acute respiratory failure, including acute respiratory distress syndrome and can identify focal and nonfocal lung morphology in these patients...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085880/setting-positive-end-expiratory-pressure-role-in-diaphragm-protective-ventilation
#23
REVIEW
Myrte Wennen, Wout Claassen, Leo Heunks
PURPOSE OF REVIEW: With mechanical ventilation, positive end-expiratory pressure (PEEP) is applied to improve oxygenation and lung homogeneity. However, PEEP setting has been hypothesized to contribute to critical illness associated diaphragm dysfunction via several mechanisms. Here, we discuss the impact of PEEP on diaphragm function, activity and geometry. RECENT FINDINGS: PEEP affects diaphragm geometry: it induces a caudal movement of the diaphragm dome and shortening of the zone of apposition...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085878/airway-pressure-release-ventilation-for-lung-protection-in-acute-respiratory-distress-syndrome-an-alternative-way-to-recruit-the-lungs
#24
REVIEW
Luigi Camporota, Louise Rose, Penny L Andrews, Gary F Nieman, Nader M Habashi
PURPOSE OF REVIEW: Airway pressure release ventilation (APRV) is a modality of ventilation in which high inspiratory continuous positive airway pressure (CPAP) alternates with brief releases. In this review, we will discuss the rationale for APRV as a lung protective strategy and then provide a practical introduction to initiating APRV using the time-controlled adaptive ventilation (TCAV) method. RECENT FINDINGS: APRV using the TCAV method uses an extended inspiratory time and brief expiratory release to first stabilize and then gradually recruit collapsed lung (over hours/days), by progressively 'ratcheting' open a small volume of collapsed tissue with each breath...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085872/ventilation-during-extracorporeal-gas-exchange-in-acute-respiratory-distress-syndrome
#25
REVIEW
Jacopo Fumagalli, Antonio Pesenti
PURPOSE OF REVIEW: Accumulating evidence ascribes the benefit of extracorporeal gas exchange, at least in most severe cases, to the provision of a lung healing environment through the mitigation of ventilator-induced lung injury (VILI) risk. In spite of pretty homogeneous criteria for extracorporeal gas exchange application (according to the degree of hypoxemia/hypercapnia), ventilatory management during extracorporeal membrane oxygenation (ECMO)/carbon dioxide removal (ECCO 2 R) varies across centers...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085871/setting-positive-end-expiratory-pressure-using-the-pressure-volume-curve
#26
REVIEW
Francesco Mojoli, Marco Pozzi, Eric Arisi
PURPOSE OF REVIEW: To discuss the role of pressure-volume curve (PV curve) in exploring elastic properties of the respiratory system and setting mechanical ventilator to reduce ventilator-induced lung injury. RECENT FINDINGS: Nowadays, quasi-static PV curves and loops can be easily obtained and analyzed at the bedside without disconnection of the patient from the ventilator. It is shown that this tool can provide useful information to optimize ventilator setting...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085868/optimal-positive-end-expiratory-pressure-weaning-in-acute-respiratory-distress-syndrome-patients
#27
REVIEW
Laura McNamara, Elias Baedorf Kassis
PURPOSE OF REVIEW: Positive-end expiratory pressure (PEEP) is a tool in managing acute respiratory distress syndrome (ARDS). In this review, we discuss the various approaches to weaning PEEP after the acute phase of ARDS. RECENT FINDINGS: There is a paucity of research specifically looking at the differences between PEEP weaning protocols. Data in some populations though, particularly those with elevated BMI, suggest that a physiologic approach to PEEP weaning may be helpful...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085866/setting-positive-end-expiratory-pressure-by-using-electrical-impedance-tomography
#28
REVIEW
Inéz Frerichs, Dirk Schädler, Tobias Becher
PURPOSE OF REVIEW: This review presents the principles and possibilities of setting positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT). It summarizes the major findings of recent studies where EIT was applied to monitor the effects of PEEP on regional lung function and to guide the selection of individualized PEEP setting. RECENT FINDINGS: The most frequent approach of utilizing EIT for the assessment of PEEP effects and the PEEP setting during the time period from January 2022 till June 2023 was based on the analysis of pixel tidal impedance variation, typically acquired during stepwise incremental and/or decremental PEEP variation...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085857/setting-positive-end-expiratory-pressure-does-the-best-compliance-concept-really-work
#29
REVIEW
Luca S Menga, Carles Subirà, Alfred Wong, Mayson Sousa, Laurent J Brochard
PURPOSE OF REVIEW: Determining the optimal positive end-expiratory pressure (PEEP) setting remains a central yet debated issue in the management of acute respiratory distress syndrome (ARDS).The 'best compliance' strategy set the PEEP to coincide with the peak respiratory system compliance (or 2 cmH 2 O higher) during a decremental PEEP trial, but evidence is conflicting. RECENT FINDINGS: The physiological rationale that best compliance is always representative of functional residual capacity and recruitment has raised serious concerns about its efficacy and safety, due to its association with increased 28-day all-cause mortality in a randomized clinical trial in ARDS patients...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38085854/setting-positive-end-expiratory-pressure-in-the-severely-obstructive-patient
#30
REVIEW
Amal Jubran
PURPOSE OF REVIEW: The response to positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation depends on the underlying pathophysiology. This review focuses on the pathophysiology of COPD, especially intrinsic PEEP (PEEPi) and its consequences, and the benefits of applying external PEEP during assisted ventilation when PEEPi is present. RECENT FINDINGS: The presence of expiratory airflow limitation and increased airway resistance promotes the development of dynamic hyperinflation in patients with COPD during acute respiratory failure...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/38062927/setting-positive-end-expiratory-pressure-the-use-of-esophageal-pressure-measurements
#31
REVIEW
Peter Somhorst, Amne Mousa, Annemijn H Jonkman
PURPOSE OF REVIEW: To summarize the key concepts, physiological rationale and clinical evidence for titrating positive end-expiratory pressure (PEEP) using transpulmonary pressure ( PL ) derived from esophageal manometry, and describe considerations to facilitate bedside implementation. RECENT FINDINGS: The goal of an esophageal pressure-based PEEP setting is to have sufficient PL at end-expiration to keep (part of) the lung open at the end of expiration. Although randomized studies (EPVent-1 and EPVent-2) have not yet proven a clinical benefit of this approach, a recent posthoc analysis of EPVent-2 revealed a potential benefit in patients with lower APACHE II score and when PEEP setting resulted in end-expiratory PL values close to 0 ± 2 cmH 2 O instead of higher or more negative values...
February 1, 2024: Current Opinion in Critical Care
https://read.qxmd.com/read/37909372/mangled-extremity-limb-salvage-for-reconstruction-versus-primary-amputation
#32
REVIEW
Thorsten Tjardes, Benedikt Marche, Sebastian Imach
PURPOSE OF REVIEW: While MESS has historically influenced limb salvage versus amputation decisions, its universal applicability remains uncertain. With trauma systems expanding and advancements in trauma care, the need for a nuanced understanding of limb salvage has become paramount. RECENT FINDINGS: Recent literature reflects a shift in the management of mangled extremities. Vascular surgery, plastic surgery, and technological advancements have garnered attention...
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909371/traumatic-spinal-cord-injury-acute-phase-treatment-in-critical-care
#33
REVIEW
Charlotte Y Adegeest, Paula V Ter Wengel, Wilco C Peul
PURPOSE OF REVIEW: Surgical timing in traumatic spinal cord injury (t-SCI) remains a point of debate. Current guidelines recommend surgery within 24 h after trauma; however, earlier timeframes are currently intensively being investigated. The aim of this review is to provide an insight on the acute care of patients with t-SCI. RECENT FINDINGS: Multiple studies show that there appears to be a beneficial effect on neurological recovery of early surgical decompression within 24 h after trauma...
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909370/editorial-acute-trauma-management-in-a-changing-environment
#34
JOURNAL ARTICLE
Marc Maegele
No abstract text is available yet for this article.
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909369/postresuscitation-management
#35
REVIEW
Wilhelm Behringer, Markus B Skrifvars, Fabio Silvio Taccone
PURPOSE OF REVIEW: To describe the most recent scientific evidence on ventilation/oxygenation, circulation, temperature control, general intensive care, and prognostication after successful resuscitation from adult cardiac arrest. RECENT FINDINGS: Targeting a lower oxygen target (90-94%) is associated with adverse outcome. Targeting mild hypercapnia is not associated with improved functional outcomes or survival. There is no compelling evidence supporting improved outcomes associated with a higher mean arterial pressure target compared to a target of >65 mmHg...
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909368/editorial-cardiopulmonary-resuscitation-2023-saving-300%C3%A2-000-additional-lives-worldwide-every-year
#36
EDITORIAL
Nadine Rott, Bernd W Böttiger
No abstract text is available yet for this article.
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909367/when-to-discontinue-renal-replacement-therapy-what-do-we-know
#37
REVIEW
Naomi Boyer, F Perschinka, Michael Joannidis, Lui G Forni
PURPOSE OF REVIEW: Acute kidney injury is common in intensive care patients. Supportive care involves the use of renal replacement therapies as organ support. Initiation of renal replacement therapy has been the subject of much interest over the last few years with several randomised controlled studies examining the optimal time to commence treatment. In contrast to this, little evidence has been generated regarding cessation of therapy. Given that this treatment is complex, not without risk and expensive it seems timely that efforts should be expended at examining this vexing issue...
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37909366/mediators-consequences-and-therapeutic-considerations-in-patients-with-acute-kidney-injury
#38
JOURNAL ARTICLE
Peter Pickkers
No abstract text is available yet for this article.
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37865873/extracorporeal-cardiopulmonary-resuscitation-in-out-of-hospital-cardiac-arrest-current-status
#39
REVIEW
Martje M Suverein, Jos G Maessen, Marcel C G van de Poll
PURPOSE OF REVIEW: Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging treatment for refractory cardiac arrest. In recent years, several randomized controlled trials have been published that aimed to address the efficacy and effectiveness of ECPR for out-of-hospital cardiac arrest (OHCA). Despite the lack of high-quality evidence concerning clinical effectiveness and cost-effectiveness, ECPR is increasingly implemented throughout the world. In this review, we aim to provide an overview of the current status of ECPR for OHCA...
December 1, 2023: Current Opinion in Critical Care
https://read.qxmd.com/read/37861213/blunt-abdominal-trauma-watch-and-wait
#40
REVIEW
Stefano Pb Cioffi, Stefania Cimbanassi, Osvaldo Chiara
PURPOSE OF REVIEW: This review examines recent advancements in nonoperative management (NOM) of hemodynamically stable blunt abdominal trauma, focusing on expanding patient selection for observation-first strategies, particularly for high-grade solid organ injuries. RECENT FINDINGS: Advances include a more deliberate nonoperative approach, allowing for broader patient inclusion in diagnostic and interventional angiography. Strict clinical monitoring and appropriate follow-up strategies are crucial to identify early signs of clinical progression and complications...
December 1, 2023: Current Opinion in Critical Care
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