Pub Date : 2024-02-01Epub Date: 2024-01-04DOI: 10.1097/MCC.0000000000001129
Lise Piquilloud
{"title":"Peep setting: let us come back to physiology.","authors":"Lise Piquilloud","doi":"10.1097/MCC.0000000000001129","DOIUrl":"10.1097/MCC.0000000000001129","url":null,"abstract":"","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.1097/mcc.0000000000001131
Amal Jubran
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.
需要机械通气的慢性阻塞性肺疾病（COPD）患者对呼气末正压（PEEP）的反应取决于潜在的病理生理学。本综述将重点关注 COPD 的病理生理学，尤其是内在 PEEP（PEEPi）及其后果，以及在辅助通气期间出现 PEEPi 时应用外部 PEEP 的益处。
{"title":"Setting positive end-expiratory pressure in the severely obstructive patient.","authors":"Amal Jubran","doi":"10.1097/mcc.0000000000001131","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001131","url":null,"abstract":"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.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1097/mcc.0000000000001126
Myrte Wennen, Wout Claassen, Leo Heunks
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.
在进行机械通气时，会使用呼气末正压（PEEP）来改善氧合和肺均匀性。然而，PEEP 的设置被认为会通过多种机制导致与危重症相关的膈肌功能障碍。在此，我们将讨论 PEEP 对膈肌功能、活动和几何形状的影响。
{"title":"Setting positive end-expiratory pressure: role in diaphragm-protective ventilation.","authors":"Myrte Wennen, Wout Claassen, Leo Heunks","doi":"10.1097/mcc.0000000000001126","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001126","url":null,"abstract":"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.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138693239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1097/mcc.0000000000001125
Jacopo Fumagalli, Antonio Pesenti
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 (ECCO2R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support.
{"title":"Ventilation during extracorporeal gas exchange in acute respiratory distress syndrome.","authors":"Jacopo Fumagalli, Antonio Pesenti","doi":"10.1097/mcc.0000000000001125","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001125","url":null,"abstract":"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 (ECCO2R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1097/mcc.0000000000001127
Francesco Mojoli, Marco Pozzi, Eric Arisi
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.
{"title":"Setting positive end-expiratory pressure: using the pressure-volume curve.","authors":"Francesco Mojoli, Marco Pozzi, Eric Arisi","doi":"10.1097/mcc.0000000000001127","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001127","url":null,"abstract":"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.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1097/mcc.0000000000001120
Peter Somhorst, Amne Mousa, Annemijn H Jonkman
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.
{"title":"Setting positive end-expiratory pressure: the use of esophageal pressure measurements.","authors":"Peter Somhorst, Amne Mousa, Annemijn H Jonkman","doi":"10.1097/mcc.0000000000001120","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001120","url":null,"abstract":"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.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138552274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1097/mcc.0000000000001123
Luigi Camporota, Louise Rose, Penny L Andrews, Gary F Nieman, Nader M Habashi
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.
{"title":"Airway pressure release ventilation for lung protection in acute respiratory distress syndrome: an alternative way to recruit the lungs.","authors":"Luigi Camporota, Louise Rose, Penny L Andrews, Gary F Nieman, Nader M Habashi","doi":"10.1097/mcc.0000000000001123","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001123","url":null,"abstract":"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.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-10-03DOI: 10.1097/MCC.0000000000001107
Johannes Zipperle, Felix C F Schmitt, Herbert Schöchl
Purpose of review: The purpose of this review is to consider the clinical value of point-of-care (POC) testing in coagulopathic trauma patients with traumatic brain injury (TBI) and trauma-induced coagulopathy (TIC).
Recent findings: Patients suffering from severe TBI or TIC are at risk of developing pronounced haemostatic disorders. Standard coagulation tests (SCTs) are insufficient to reflect the complexity of these coagulopathies. Recent evidence has shown that viscoelastic tests (VETs) identify haemostatic disorders more rapidly and in more detail than SCTs. Moreover, VET results can guide coagulation therapy, allowing individualised treatment, which decreases transfusion requirements. However, the impact of VET on mortality remains uncertain. In contrast to VETs, the clinical impact of POC platelet function testing is still unproven.
Summary: POC SCTs are not able to characterise the complexity of trauma-associated coagulopathy. VETs provide a rapid estimation of underlying haemostatic disorders, thereby providing guidance for haemostatic therapy, which impacts allogenic blood transfusion requirements. The value of POC platelet function testing to identify platelet dysfunction and guide platelet transfusion is still uncertain.
{"title":"Point-of-care, goal-directed management of bleeding in trauma patients.","authors":"Johannes Zipperle, Felix C F Schmitt, Herbert Schöchl","doi":"10.1097/MCC.0000000000001107","DOIUrl":"10.1097/MCC.0000000000001107","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to consider the clinical value of point-of-care (POC) testing in coagulopathic trauma patients with traumatic brain injury (TBI) and trauma-induced coagulopathy (TIC).</p><p><strong>Recent findings: </strong>Patients suffering from severe TBI or TIC are at risk of developing pronounced haemostatic disorders. Standard coagulation tests (SCTs) are insufficient to reflect the complexity of these coagulopathies. Recent evidence has shown that viscoelastic tests (VETs) identify haemostatic disorders more rapidly and in more detail than SCTs. Moreover, VET results can guide coagulation therapy, allowing individualised treatment, which decreases transfusion requirements. However, the impact of VET on mortality remains uncertain. In contrast to VETs, the clinical impact of POC platelet function testing is still unproven.</p><p><strong>Summary: </strong>POC SCTs are not able to characterise the complexity of trauma-associated coagulopathy. VETs provide a rapid estimation of underlying haemostatic disorders, thereby providing guidance for haemostatic therapy, which impacts allogenic blood transfusion requirements. The value of POC platelet function testing to identify platelet dysfunction and guide platelet transfusion is still uncertain.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49675363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：