Acoustic monitoring – super sonics?

Vesicular breath sounds, wheezes, rhonchi, and crackles possess acoustic 'signatures' amenable to detection, quantification, and moment-by-moment visual display. Despite technical hurdles, new methods for sonic evaluation, once perfected, should offer innovative diagnostic and monitoring tools that add clinical value. These emerging options complement current 'static/global' monitoring of mechanics and gas exchange with dynamic regional information long missing from the optimal care of the ventilated patient with critical illness

Safer ventilation of the injured lung: one step closer

Prevention of iatrogenic injury due to ventilation of a heterogeneous lung requires knowledge of dynamic regional events occurring within the tidal cycle. Quantitative bedside imaging techniques that are sensitive to regional mechanics and tidal events hold potential for information delivery that cannot be realized by pressure-volume monitoring alone

How best to recruit the injured lung?

Sustained re-opening of collapsed lung tissue (recruitment) requires the application of airway pressures that exceed those of the tidal cycle. The post-maneuver PEEP as well as the duration of high pressure application are also key factors in its success, with their accompanying potential for hemodynamic compromise. Although a wide variety of recruiting maneuvers have been described, the technique that strikes the best balance between efficacy and risk may well vary among patients with differing right heart loading status and lung properties

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