Lung protective ventilatory strategies—will these prevail in the next millennium?

Keogh, Brian F; Bateman, C

doi:10.1093/bja/83.6.829

Cited by 6 publications

(4 citation statements)

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“…Amato et al (1998) showed a reduction in mortality from 71 to 38% in patients (nˆ53) receiving protective ventilation (P < 0.001). Protective ventilation consisted of tidal volumes less than 6 mL=kg, and PEEP above the lower in¯ection point on the static pressure±volume curve (Keogh and Bateman, 1999;Gattinoni et al, 1995a). A driving pressure less than 20 cmH 2 O above PEEP was aimed for, with preferential use of pressure-limited ventilation modes.…”

Section: Low Tidal Volume Ventilation In Acute Lung Injury = Acute Respiratory Distress Syndromementioning

confidence: 99%

Current concepts in the diagnosis and management of trauma-related sepsis

Easby

Greaves

2004

Trauma

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Traumatic injury is common, and accounts for a large health care burden. Trauma and in particular haemorrhagic shock are closely related to the onset of multiple organ failure, the systemic inflammatory response and sepsis. Despite overall improvements in the care of septic critically ill patients there has been little impact on morbidity and mortality. In recent years our understanding of sepsis both as an illness and at a molecular level has led to the development of a number of therapeutic interventions. This article outlines the current evidence for such interventions and points to possible future research that is required in the diagnosis and management of trauma-related sepsis.

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Section: Low Tidal Volume Ventilation In Acute Lung Injury = Acute Respiratory Distress Syndromementioning

confidence: 99%

Current concepts in the diagnosis and management of trauma-related sepsis

Easby

Greaves

2004

Trauma

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“…The lower inflection point of this compliance curve is theoretically the pressure at which less stable lung units collapse and re-open. It has been suggested that PEEP should be set above this pressure and this results in levels of PEEP somewhat higher than traditionally used (Keogh et al, 1999;. Several studies have examined the use of protective ventilation strategies in ARDS patients with conflicting results (Amato et al, 1998;Brochard et al, 1998;Stewart et al, 1998), although the largest study so far does provide evidence of benefit.…”

Section: Mechanical Ventilationmentioning

confidence: 99%

The systemic inflammatory response syndrome

Meeran

Messent

2001

Trauma

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The systemic inflammatory response syndrome (SIRS) describes the clinical presentation of patients with systemic activation of the inflammatory response from any underlying cause. SIRS is a common problem in acute medical and surgical practice and an important cause of morbidity and mortality. As a consequence of SIRS, patients may develop multiple organ dysfunction syndrome and acute respiratory distress syndrome (ARDS). Over the recent years our understanding of the inflammatory response in SIRS has increased, but as yet specific immunomodulatory therapies have not proved useful. The mainstay of treatment for patients with SIRS and ARDS remains a general supportive care. It is in this area that more encouraging advances are being made, particularly in the management of invasive ventilation and nutrition. In this review we summarize the definitions, epidemiology and pathophysiology of SIRS, ARDS and related conditions. We then give a description of the clinical consequences and treatment of SIRS and ARDS with an emphasis on current aspects of supportive care.

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“…The so called 'lung protective ventilation strategies' are being widely investigated and applied worldwide, also influencing current clinical practice [4]. Despite the indicated trends of the researches, the evidence of efficacy or outcome benefits of these techniques is still limited.…”

Section: Introductionmentioning

confidence: 99%

Experimental evaluation of errors in the measurement of respiratory parameters of the newborn performed by a continuous flow neonatal ventilator

Cappa

Sciuto

Silvestri

2006

Journal of Medical Engineering & Technology

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Pulmonary ventilators for intensive care provide information on, among many other patient respiratory parameters, patient resistance, compliance and 'work of breathing' values calculated from pressure and flow data patterns according to a widely utilized algorithm. The effects induced by the breathing circuit and analogue filtering of the ventilator measuring system are experimentally investigated during controlled ventilation. Three main phenomena are observed: (a) errors in calculation of resistance and compliance due to filtering of pressure and flow waveforms; (b) the presence of pressure oscillations at the beginning of inspiration and expiration phases; and (c) the phase shift between pressure and flow waveforms. The experimental evaluation of the measuring system of a neonatal ventilator is then conducted and: (a) a delay in pressure and flow measurement synchronization equal to 22 +/- 2 ms is evaluated; moreover, (b) a difference between the values provided by the ventilator and those measured by the reference experimental setup on respiratory parameters such as the compliance, resistance and work of breathing that lies in the range of 7-16% of reading is observed.

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Lung protective ventilatory strategies—will these prevail in the next millennium?

Cited by 6 publications

References 0 publications

Current concepts in the diagnosis and management of trauma-related sepsis

Current concepts in the diagnosis and management of trauma-related sepsis

The systemic inflammatory response syndrome

Experimental evaluation of errors in the measurement of respiratory parameters of the newborn performed by a continuous flow neonatal ventilator

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