32,008 research outputs found
“I feel how you feel”: reflections about empathy in the relationship between ICU physicians and relatives
No full textAnother brick in the wall of needs for invasive ventilation?
No full textVentilator-induced lung injury and ventilator-induced diaphragmatic dysfunction are major complications in mechanically ventilated patients with acute respiratory failure. Invasive ventilation adds a further burden by increasing the risk of infections. An approach that protects both lung and diaphragm is pivotal. Mirabella and colleagues compared conventional controlled ventilation with a mode that combines several potentially lung-protective properties - non-invasively applied neurally adjusted ventilatory assist - in an animal experiment. This approach seemed to be as effective but potentially more lung-protective. Although the experimental setup and results cannot be translated directly to the clinical setting, they should motivate us to further study this innovative approach
Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems
No full textExtracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H(2)O) in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that, at least in some patients, a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments, thus reducing the procedure-related risks. However, what is true for ventilator settings should also be true for extracorporeal procedures: studies will have to demonstrate a convincing risk-benefit ratio. In addition, a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange, the 'optimal' tidal volume/positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined
How ARDS should be treated
No full textThe Berlin definition criteria applied at positive end-expiratory pressure (PEEP) 5 cm H2O reasonably predict lung edema and recruitabilty. To maintain viable gas exchange, the mechanical ventilation becomes progressively more risky going from mild to severe acute respiratory distress syndrome (ARDS). Tidal volume, driving pressure, flow, and respiratory rate have been identified as causes of ventilation-induced lung injury. Taken together, they represent the mechanical power applied to the lung parenchyma. In an inhomogeneous lung, stress risers locally increase the applied mechanical power. Increasing lung homogeneity by PEEP and prone position decreases the harm of mechanical ventilation, particularly in severe ARDS
Bridge or Abyss: Extracorporeal Membrane Oxygenation for Acute Respiratory Failure in Interstitial Lung Disease
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F ifty Y ears of R esearch in ARDS Why Is Acute Respiratory Distress Syndrome So Important for Critical Care?
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Forced-air warming: technology, physical background and practical aspects
No full textPurpose of review There is an ever-increasing number of forced-air warming devices available in the market. However, there is also a paucity of studies that have investigated the physical background of these devices, making it difficult to find the most suitable ones. Recent findings Heat flow produced by power units depends on the air temperature at the nozzle and the airflow. The heat transfer from the blanket to the body surface depends on the heat exchange coefficient, the temperature gradient between the blanket and the body surface and the area that is covered. Additionally, the homogeneity of heat distribution inside the blanket is very important. The lower the temperature difference between the highest and the lowest blanket temperature, the better the performance of the blanket. Summary The efficacy of a forced-air warming system is mainly determined by the design of the blankets. A good forced-air warming blanket can easily be detected by measuring the temperature difference between the highest blanket temperature and the lowest blanket temperature. This temperature difference should be as low as possible. Because of the limited efficacy of forced-air warming systems to prevent hypothermia, patients must be prewarmed for 30-60 min even if a forced-air warming system is used during the operation. During the operation, the largest blanket that is possible for the operation should be used
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