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There might be no safe ventilation. Much too often, all there is for us to measure at the bedside are nothing but global indicators of stress/strain, more or less refined. Heterogeneity at the alveolar level-inhomogeneities or stress raisers - render global parameters less useful than previously predicted. In fact, Mead had already stated it through his work on stress distribution at the alveolar level. ECMO (VA ECMO) might be regarded as one other way of decatecholaminization (M.Singer). Stop stressing the already stressed heart. Unfortunately, fem-fem VA ECMO still needs inotropic support to lessen the LV distension. Levosimendan and IABP combined could help decrease the catecholamine usage in this context.
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Smith hfov adult ards july 2007
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High-frequency oscillatory ventilation
in adults Geoff Smith SICU July 2007
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