83 research outputs found
High-frequency oscillation and tracheal gas insufflation in patients with severe acute respiratory distress syndrome and traumatic brain injury: an interventional physiological study
In acute respiratory distress syndrome (ARDS), combined high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves gas exchange compared with conventional mechanical ventilation (CMV). We evaluated the effect of HFO-TGI on PaO2/fractional inspired O2 (FiO2) and PaCO2, systemic hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) in patients with traumatic brain injury (TBI) and concurrent severe ARDS
Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea
SCOPUS: re.jinfo:eu-repo/semantics/publishe
Year in review in Intensive Care Medicine 2010: III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics
SCOPUS: re.jinfo:eu-repo/semantics/publishe
Second- and Third-Tier Therapies for Severe Traumatic Brain Injury
Intracranial hypertension is a common finding in patients with severe traumatic brain injury. These patients need treatment in the intensive care unit, where intracranial pressure monitoring and, whenever possible, multimodal neuromonitoring can be applied. A three-tier approach is suggested in current recommendations, in which higher-tier therapies have more significant side effects. In this review, we explain the rationale for this approach, and analyze the benefits and risks of each therapeutic modality. Finally, we discuss, based on the most recent recommendations, how this approach can be adapted in low- and middle-income countries, where available resources are limited
Static pressure-volume curves and body posture in severe chronic bronchitis
Based on prior data, the current authors hypothesised that beneficial
pronation effects on gas exchange and respiratory mechanics might be
maximised in severely hyperinflated chronic bronchitis patients. The
current authors also sought to elucidate underlying mechanisms and to
determine whether pronation effects are reflected by postural changes in
inspiratory pressure-volume (P-V) curve characteristics.
A total of 16 mechanically ventilated patients (for 16-36 h) with
chronic bronchitis exacerbation were studied in pre-prone semirecumbent
(SREC), prone and post-prone SREC postures. Static respiratory system
intrinsic positive end-expiratory pressure (PEEPi,rs) was > 12 cmH(2)O
Haemodynamics, partitioned respiratory mechanics, gas exchange, and lung
volumes were determined at zero external positive end-expiratory
pressure. P-V curves were constructed from functional residual capacity.
End-expiratory lung volume exceeded opening volume. Prone position
versus pre-prone SREC resulted in 20% reduced pressure at the lower
inflection point (LIP) and 17% increased volume at the upper inflection
point of the lung P-V curve, improved lung mechanics and volumes,
oxygenation, and carbon dioxide arterial tension (Pa,co(2)). In multiple
linear regression, postural decreases in PEEPi,rs and additional lung
resistance independently predicted postural decreases in lung LIP
pressure and Pa,co(2), respectively.
In conclusion, in severely hyperinflated patients, pronation reduces
lung lower inflection point pressure and increases lung upper inflection
point volume. Pronation effects on ventilation homogeneity and carbon
dioxide arterial tension are maximised, implying that pronation can be
useful during early controlled ventilation
COVID-19-Related ARDS: Key Mechanistic Features and Treatments
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome historically characterized by the presence of severe hypoxemia, high-permeability pulmonary edema manifesting as diffuse alveolar infiltrate on chest radiograph, and reduced compliance of the integrated respiratory system as a result of widespread compressive atelectasis and fluid-filled alveoli. Coronavirus disease 19 (COVID-19)-associated ARDS (C-ARDS) is a novel etiology caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may present with distinct clinical features as a result of the viral pathobiology unique to SARS-CoV-2. In particular, severe injury to the pulmonary vascular endothelium, accompanied by the presence of diffuse microthrombi in the pulmonary microcirculation, can lead to a clinical presentation in which the severity of impaired gas exchange becomes uncoupled from lung capacity and respiratory mechanics. The purpose of this review is to highlight the key mechanistic features of C-ARDS and to discuss the implications these features have on its treatment. In some patients with C-ARDS, rigid adherence to guidelines derived from clinical trials in the pre-COVID era may not be appropriate
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