Respiratory care clinics of North America最新文献

A nutritional strategy to improve oxygenation and decrease morbidity in patients who have acute respiratory distress syndrome. 急性呼吸窘迫综合征患者改善氧合和降低发病率的营养策略。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.006

Stephen J DeMichele, Steven M Wood, Ann K Wennberg

引用次数: 17

Feeding the critically ill obese patient: the role of hypocaloric nutrition support. 危重肥胖患者的喂养:低热量营养支持的作用。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.002

Jerad P Miller, Patricia Smith Choban

引用次数: 11

Indirect calorimetry: relevance to patient outcome. 间接量热法:与患者预后的相关性。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.008

Stephen A McClave

引用次数: 10

Malnutrition in chronic obstructive pulmonary disease. 慢性阻塞性肺疾病的营养不良。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.001

Denise Baird Schwartz

引用次数: 55

Indirect calorimetry: applications in practice. 间接量热法:实际应用。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.005

Jennifer A Wooley

引用次数: 8

Nutrition support in the acutely ventilated patient. 急性通气患者的营养支持。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.004

Mark H Oltermann

{"title":"Nutrition support in the acutely ventilated patient.","authors":"Mark H Oltermann","doi":"10.1016/j.rcc.2006.09.004","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.09.004","url":null,"abstract":"Although the nutrition support literature is limited and therefore does not provide robust evidence to promote grade A or strong recommendations, there is a \"signal\" from all of these studies taken a a whole that critically ill patients may benefit from nutritional manipulation. The acutely ventilated patient that is likely to still be intubated by day three is a classic example of the critically ill patient who has the potential to achieve positive outcomes with nutritional support. Initiating nutrition support early improves the chances of benefit. However, nutrition cannot be provided in a vacuum. It is only one part of a multitude of treatments and therapies that must be optimally applied by a multidisciplinary team of professionals dedicated to the care of ICU patients. The exact makeup of the enteral (or parenteral) formula that is most likely to improve survival is unclear. More research is needed. Further study may demonstrate the possibility for nutritional manipulation to be one of the most important treatments physicians can offer to critically ill ventilated patients. Nutrition may have as much survival benefit as activated protein C, a drug costing over $7000 per course of therapy. No longer can it be said that nutrition makes no difference.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 4","pages":"533-45"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26426932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Nutrition support for the long-term ventilator-dependent patient. 长期呼吸机依赖患者的营养支持。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.003

Gail Cresci, Jorge I Cué

引用次数: 5

Strategies to prevent aspiration-related pneumonia in tube-fed patients. 预防管饲患者吸入相关性肺炎的策略。

Respiratory care clinics of North America Pub Date : 2006-12-01 DOI: 10.1016/j.rcc.2006.09.007

Norma A Metheny

引用次数: 3

Is permissive hypercapnia a beneficial strategy for pediatric acute lung injury? 允许性高碳酸血症是治疗小儿急性肺损伤的有益策略吗?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.001

Alexandre T Rotta, David M Steinhorn

{"title":"Is permissive hypercapnia a beneficial strategy for pediatric acute lung injury?","authors":"Alexandre T Rotta, David M Steinhorn","doi":"10.1016/j.rcc.2006.06.001","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.06.001","url":null,"abstract":"It is clear that mechanical ventilation strategies influence the course of lung disease, and the choice of a ventilation strategy that avoids volutrauma and atelectrauma is firmly based on experimental literature and clinical experience. The application of a lung-protective strategy with reduced tidal volumes, effective lung recruitment, adequate PEEP to minimize alveolar collapse during expiration, and permissive hypercapnia has been shown to be advantageous in adult patients who have ARDS, although it has not been systematically studied in children. A significant body of literature confirms the beneficial effects of hypercapnic acidemia in the setting of acute lung injury. As a corollary, experimental evidence indicates that buffering hypercapnic acidosis abrogates its protective effects. The use of permissive hypercapnia as part of a lung-protective strategy in children should be accepted and perhaps even desired, provided it does not result in significant hemodynamic instability. This acceptance should be tempered with the recognition that a low-stretch, reduced-tidal volume strategy without hypercapnia has also been shown to improve outcomes in adults who have ARDS and that HFOV can generally provide lung-protective ventilation without necessarily inducing hypercapnia. Thus, a synthesis of the available clinical and research data strongly supports a graded approach to managing patients who have acute lung injury requiring intubation. The highest priority should be a mechanical ventilation strategy that limits the tidal volume, with the allowance of hypercapnia to a degree that does not compromise hemodynamic status.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"371-87"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26237203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 20

Is high-frequency ventilation more beneficial than low-tidal volume conventional ventilation? 高频通风比低潮气量常规通风更有益吗?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.05.004

Irina S Ten, Michael R Anderson

{"title":"Is high-frequency ventilation more beneficial than low-tidal volume conventional ventilation?","authors":"Irina S Ten, Michael R Anderson","doi":"10.1016/j.rcc.2006.05.004","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.05.004","url":null,"abstract":"The ventilator goals of the ICU clinician faced with caring for a critically ill child who has ALI/ARDS remain relatively simple: provide adequate ventilation and oxygenation without overdistending alveoli or furthering lung injury. How one obtains these goals is much less simple. The current use of CV calls for the use of relatively low V(T)s and limiting peak inspiratory pressure and plateau pressure while accepting a certain degree of respiratory acidosis. The ICU team can also often achieve these same goals with HFOV. How, then, does one use evidenced-based medicine to pick the best mode of mechanical ventilation for a particular patient? The answer is controversial, to say the least. Does one start with a gentle, open-lung mode of CV then switch to HFOV if the child deteriorates? Or does one use HFOV from the very early stages of ALI? Animal data appear to point to advantages of HFOV when used early in the course of ALI. Most of these studies report a beneficial effect of HFOV when applied on expanded lungs in the early stages of the disease process. These beneficial effects encompass improved gas exchange, oxygenation, lung tissue morphology and pulmonary mechanics. The studies by Arnold and colleagues in the pediatric population also help to answer our questions. In their work, the early initiation of HFOV was associated with improved gas exchange and a trend toward a lower mortality. In adults, Derdak and colleagues demonstrated the superiority of HFOV in terms of gas exchange and oxygenation; however, no statistical significant difference was found for mortality. So, where is the clinician left after a review of these data? It would appear that (1) low-V(T) CV remains a cornerstone of therapy for the pediatric patient who has ALI/ARDS; (2) HFOV is a safe and well-tolerated mode of mechanical ventilation; (3) early use of HFOV (as opposed to the rescue use of this mode) may be of benefit based on animal and human data; and (4) like so many areas of pediatric critical care, clinicians must await new data and trials that will help them continue to improve the care they provide.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"437-51"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26295187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11