호흡기내과 의사를 위한 Respiratory Review of 2010

Other Titles
Critical Care Medicine
Authors
박지혜채진녕최원일
Department
Dept. of Internal Medicine (내과학)
Issue Date
2010
Citation
Tuberculosis and Respiratory Diseases, Vol.69(2) : 75-80, 2010
ISSN
1738-3536
Abstract
The year of 2009∼2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources. Key Words: Critical Care; Respiratory Distress Syndrome, Adult; Extracorporeal Membrane Oxygenation; Glucose; Infection
Keywords
Critical CareRespiratory Distress SyndromeAdultExtracorporeal Membrane OxygenationGlucoseInfection
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34785
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
Keimyung Author(s)
최원일
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