Critical care medicine
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Critical care medicine · Mar 2005
Review Comparative StudyProtocols for lung protective ventilation.
Protocols have a well-established role in clinical research and are increasingly being used to direct routine clinical care. In this article, we review the differing goals of research and clinical protocols and outline the similar process for their development. We use the mechanical ventilation protocol of the ARDS Network trial comparing small with traditional tidal volumes as an example. As a starting point for debate, we also suggest guiding principles and specific components of a protocol for high-frequency oscillatory ventilation.
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Critical care medicine · Mar 2005
ReviewHigh-frequency oscillatory ventilation: lessons learned from mechanical test lung models.
Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. ⋯ Mechanical test lung and artificial trachea simulations may provide useful information on the interaction of HFOV with altered lung mechanics and may contribute to the formulation of HFOV clinical strategies. Important limitations of these models include absence of gas exchange, histologic and biologic markers, or hemodynamic data.
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Critical care medicine · Mar 2005
ReviewHigh-frequency oscillatory ventilation and adjunctive therapies: inhaled nitric oxide and prone positioning.
To review the use of high-frequency oscillatory ventilation (HFOV) with adjunctive therapies (inhaled nitric oxide [iNO] and prone positioning [PP]) in adult patients with acute respiratory distress syndrome (ARDS). ⋯ There is limited clinical data to recommend the widespread use of combination therapy in patients with ARDS. In the subset of patients with life-threatening hypoxemia from refractory ARDS, combination therapy is safe and may be considered for salvage therapy. More rigorous randomized, controlled trials are needed to help delineate the therapeutic role of combination therapy in adults with ARDS.