Untitled

Abstract

In patients with acute respiratory distress syndrome (ARDS), the lung comprises areas of aeration and areas of alveolar collapse, the latter producing intrapulmonary shunt and hypoxemia. The currently suggested strategy of ventilation with low lung volumes can aggravate lung collapse and potentially produce lung injury through shear stress at the interface between aerated and collapsed lung, and as a result of repetitive opening and closing of alveoli. An 'open lung strategy' focused on alveolar patency has therefore been recommended. While positive end-expiratory pressure prevents alveolar collapse, recruitment maneuvers can be used to achieve alveolar recruitment. Various recruitment maneuvers exist, including sustained inflation to high pressures, intermittent sighs, and stepwise increases in positive end-expiratory pressure or peak inspiratory pressure. In animal studies, recruitment maneuvers clearly reverse the derecruitment associated with low tidal volume ventilation, improve gas exchange, and reduce lung injury. Data regarding the use of recruitment maneuvers in patients with ARDS show mixed results, with increased efficacy in those with short duration of ARDS, good compliance of the chest wall, and in extrapulmonary ARDS. In this review we discuss the pathophysiologic basis for the use of recruitment maneuvers and recent evidence, as well as the practical application of the technique.

Frequency, Urinalysis and Susceptibility Profile of Pathogens Causing Urinary Tract Infections in Enugu State, Southeast Nigeria

“…6%), Staphylococcus species (17.4%), Staphylococcus aureus (11.6%), Proteus species (11.6%), Pseudomonas aeruginosa (10.1%), Candida species (10.1%), Enterobacter species (7.2%), Klebsiella species (4.3%) and Candida albicans (2.9%). This agrees with the findings of LAUPLAUD et al 11 which gave the percentage of E. coli implicated in urine of patients in Calgary Health Region Intensive Care Unit in Canada as 23%. Only 2.9% of Candida albicans were recovered compared to 20% found by LAUPLAUD and co-workers 11 suggesting that they were not nosocomial infections.…”

Chateter-associated Urinary Tract Infections in Adults

“…The research showed that, during the past 10 years, Candida spp. was more often being isolated as an etiologic factor of those infections, 20 to 44.4% (12, 13). …”

Efficacy and safety of lung recruitment in pediatric patients with acute lung injury

“…Recruitment maneuvers (RMs) can prevent lung collapse by temporarily increasing transpulmonary pressure (9). Animal studies show that RMs improve oxygenation and may attenuate derecruitment-associated lung injury (10, 11).…”

“…Animal studies show that RMs improve oxygenation and may attenuate derecruitment-associated lung injury (10, 11). However, the efficacy of RMs in adults and pediatrics remains controversial (9). Some studies suggest a benefit in mortality and physiological parameters such as oxygenation and dynamic respiratory system compliance (6, 12–28).…”

“…Diverse methods for lung recruitment have been described in the medical literature (9). RMs can be applied by increasing volume or pressure over time.…”