Minerva anestesiologica
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Minerva anestesiologica · Aug 2019
Randomized Controlled Trial Multicenter StudyProportional Assist Ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial.
Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV). ⋯ The use of high-assistance PAV+ in the early phase of MV does not present benefits compared to V-ACV. The high rate of PAV+ failure reinforces the need for sedative optimization, learning curve, and better patient selection.
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Minerva anestesiologica · Aug 2019
Randomized Controlled TrialVeno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome: should the EOLIA Study results change our clinical approach?
The original discouraging results of extracorporeal membrane oxygenation (ECMO) application in acute respiratory failure caused the technique to be almost abandoned. Fortunately, ECMO survived thanks to the good results obtained in neonates. The interest on ECMO renewed after the publication of the CESAR Trial in 2009. ⋯ In 2018 the group of investigators led by Alain Combes designed and implemented the EOLIA Study to test the efficacy of veno-venous ECMO in patients with severe acute respiratory distress syndrome (ARDS). This article discusses the primary and secondary results of the trial and the considerations emerged in the medical community. We will also discuss how ECMO could evolve to maximize lung protection rather than just prevent hypoxic death.