Intensive care medicine
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Intensive care medicine · Oct 2015
Randomized Controlled Trial Comparative StudyEffect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial.
To evaluate the efficacy of a quality improvement (QI) program for protocol-directed weaning from mechanical ventilation. ⋯ The QI program involving protocol-directed weaning is associated with beneficial clinical outcomes in mechanically ventilated patients.
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Intensive care medicine · Oct 2015
ReviewExtracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review.
Extracorporeal carbon dioxide removal (ECCO2R) has been proposed for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) exacerbations, to avoid intubation or reduce length of invasive ventilation. Balance of risks, efficacy, and benefits of ECCO2R in patients with COPD is unclear. ⋯ The technique is still experimental and no randomized trial is available. Recognizing selection bias associated with case series, there still appears to be potential for benefit of ECCO2R in patients with COPD exacerbations. However, it is associated with frequent and potentially severe complications. Higher-quality studies are required to better elucidate this risk-benefit balance.