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Purpose: Although noninvasive ventilation (NIV) may reduce reintubation in patients with acute hypoxemic respiratory failure following abdominal surgery, this strategy has not been specifically assessed in patients with obesity. Methods: We conducted a post hoc analysis of a multicenter randomized controlled trial comparing NIV delivered via facial mask to standard oxygen therapy among patients with obesity and acute hypoxemic respiratory failure within 7 days after abdominal surgery. The primary outcome was reintubation within 7 days. Secondary outcomes were invasive ventilation-free days at day 30, intensive care unit (ICU)-acquired pneumonia and 30-day survival. Results: Among 293 patients with hypoxemic respiratory failure following abdominal surgery, 76 (26%) patients had obesity and were included in the intention-to-treat analysis. Reintubation rate was significantly lower with NIV (13/42, 31%) than with standard oxygen therapy (19/34, 56%) within 7 days (absolute difference: − 25%, 95% confidence interval (CI) − 49 to − 1%, p = 0.03). NIV was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (27.1 ± 8.6 vs 22.7 ± 11.1 days; p = 0.02), while fewer patients developed ICU-acquired pneumonia (1/42, 2% vs 6/34, 18%; p = 0.04). The 30-day survival was 98% in the NIV group (41/42) versus 85% in the standard oxygen therapy (p = 0.08). In patients with body mass index (BMI) < 30 kg/m2, no significant difference was observed between NIV (36/105, 34%) and standard oxygen therapy (47/109, 43%, p = 0.03). An interaction test showed no statistically significant difference between the two subsets (BMI ≥ 30 kg/m2 and BMI < 30 kg/m2). Conclusions: Among patients with obesity and hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of reintubation within 7 days, contrary to patients without obesity. However, no interaction was found according to the presence of obesity or not, suggesting either a lack of power to conclude in the non-obese subgroup despite existing differences, or that the statistical difference found in the overall sample was driven by a large effect in the obese subsets. [ABSTRACT FROM AUTHOR]

Consider abdominal computed tomography scan in the early course to exclude differential diagn... Early abdominal computed tomography (CT) scan within the first days after symptom onset is unreliable to detect the degree of necrosis or the presence of complications and, therefore, rarely modifies diagnosis and treatment [[6]]. The prevalence of acute pancreatitis has continuously increased over the past decades. Although the majority of patients with acute pancreatitis presents with mild, interstitial oedematous pancreatitis and fully recovers with supportive treatment within a few days, more than 10% develop a more severe course requiring hospitalisation in an intensive care unit (ICU) [[1]]. [Extracted from the article]

Background: Combining oxygen facemask with apnoeic oxygenation using high-flow-nasal-oxygen (HFNO) for preoxygenation in the operating room has not been studied against standard oxygen facemask alone. We hypothesized that facemask-alone would be associated with lower levels of lowest end-tidal oxygen (EtO2) within 2 min after intubation in comparison with facemask combined with HFNO. Methods: In an international prospective before–after multicentre study, we included adult patients intubated in the operating room from September 2022 to December 2022. In the before period, preoxygenation was performed with facemask-alone, which was removed during laryngoscopy. In the after period, facemask combined with HFNO was used for preoxygenation and HFNO for apnoeic oxygenation during laryngoscopy. HFNO was maintained throughout intubation. The primary outcome was the lowest EtO2 within 2 min after intubation. The secondary outcome was SpO2 ≤ 95% within 2 min after intubation. Subgroup analyses were performed in patients without and with obesity. This study was registered 10 August 2022 with ClinicalTrials.gov, number NCT05495841. Results: A total of 450 intubations were evaluated, 233 with facemask-alone and 217 with facemask combined with HFNO. In all patients, the lowest EtO2 within 2 min after intubation was significantly lower with facemask-alone than with facemask combined with HFNO, 89 (85–92)% vs 91 (88–93)%, respectively (mean difference − 2.20(− 3.21 to − 1.18), p < 0.001). In patients with obesity, similar results were found [87(82–91)% vs 90(88–92)%, p = 0.004]; as in patients without obesity [90(86–92)% vs 91(89–93)%, p = 0.001)]. SpO2 ≤ 95% was more frequent with facemask-alone (14/232, 6%) than with facemask combined with HFNO (2/215, 1%, p = 0.004). No severe adverse events were recorded. Conclusions: Combining facemask with HFNO for preoxygenation and apnoeic oxygenation was associated with increased levels of lowest EtO2 within 2 min after intubation and less desaturation. [ABSTRACT FROM AUTHOR]

9362963 5 Roberts J. Machines that help machines to help patients: optimizing drug dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy. Indeed, since critically ill patients need constant, close monitoring and support, organ suppliance machines and medications to preserve organ function, the ICU is one of hospital departments in which are deployed most of the "machines to better treat patients" and probably "to save lives". In 1952, a devastating polio epidemic arose in Copenhagen (Denmark), which resulted in thousands of patients requiring artificial ventilation for severe respiratory failure. This special issue entitled "Machines that save lives" provides a state-of-the-art update by the most renowned world experts on extracorporeal organ support (ECOS) machines and monitoring devices used to treat patients in the intensive care unit (ICU). [Extracted from the article]

Purpose: The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.Methods: In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.Results: A total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).Conclusions: Among critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success. [ABSTRACT FROM AUTHOR]

Background: The effect of cytomegalovirus (CMV) reactivation on the length of mechanical ventilation and mortality in immunocompetent ICU patients requiring invasive mechanical ventilation remains controversial. The main objective of this study was to determine whether preemptive intravenous ganciclovir increases the number of ventilator-free days in patients with CMV blood reactivation. Methods: This double-blind, placebo-controlled, randomized clinical trial involved 19 ICUs in France. Seventy-six adults ≥ 18 years old who had been mechanically ventilated for at least 96 h, expected to remain on mechanical ventilation for ≥ 48 h, and exhibited reactivation of CMV in blood were enrolled between February 5th, 2014, and January 23rd, 2019. Participants were randomized to receive ganciclovir 5 mg/kg bid for 14 days (n = 39) or a matching placebo (n = 37). Results: The primary endpoint was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included day 60 mortality. The trial was stopped for futility based on the results of an interim analysis by the DSMB. The subdistribution hazard ratio for being alive and weaned from mechanical ventilation at day 60 for patients receiving ganciclovir (N = 39) compared with control patients (N = 37) was 1.14 (95% CI from 0.63 to 2.06; P = 0.66). The median [IQR] numbers of ventilator-free days for ganciclovir-treated patients and controls were 10 [0–51] and 0 [0–43] days, respectively (P = 0.46). Mortality at day 60 was 41% in patients in the ganciclovir group and 43% in the placebo group (P =.845). Creatinine levels and blood cells counts did not differ significantly between the two groups. Conclusions: In patients mechanically ventilated for ≥ 96 h with CMV reactivation in blood, preemptive ganciclovir did not improve the outcome. [ABSTRACT FROM AUTHOR]

The year 2018 in mechanical ventilation and acute respiratory distress syndrome (ARDS) was marked by the struggle to develop personalized or precision medicine, defined as "the tailoring of medical treatment to the individual characteristics of each patient with ARDS". 1 Patient and ARDS characteristics highlighted in papers published in 2018 for individualizing ARDS management. However, a recent retrospective study found no impact of driving pressure on 90-day mortality in 100 obese (BMI >= 30) patients, in contrast to 262 non-obese ARDS patients [[5]]. These results suggest that ARDS in obese patients (often excluded from large studies assessing therapies in ARDS) may differ from ARDS in non-obese patient. [Extracted from the article]

The article discusses the challenges faced by journals and academics in finding reviewers for scholarly manuscripts. A survey of reviewers from biomedical journals reveals that conflicting workload demands and tight deadlines are the primary reasons for declining review invitations. The declining enthusiasm for peer review poses a threat to the quality and integrity of academic discourse. To address this issue, some journals have started incentivizing the peer review process by offering Continuing Medical Education credits and opportunities for professional development. The article suggests several strategies to enhance reviewer participation, including providing clear scope, offering step-by-step review guidance, empowering reviewers through training, rethinking incentives, and leveraging artificial intelligence assistance. By addressing the needs and motivations of reviewers, the academic community can create a more engaging and rewarding peer review process. [Extracted from the article]

A recent clinical trial conducted by Freund and colleagues investigated the impact of a 1-hour sepsis bundle in emergency departments for patients with suspected sepsis. The trial found that this intervention did not improve 28-day in-hospital mortality compared to standard care. The trial's design and execution were commendable, but it highlighted the challenges of designing future clinical trials in sepsis. The trial also raised questions about the feasibility of strict timeframes for intervention and the selection of appropriate endpoints. Overall, while the trial did not show significant improvement in outcomes, it provides valuable insights into the complexities of sepsis management and the need for a nuanced approach. [Extracted from the article]

In contrast to an opioid-induced drop in blood pressure, the clinician would prefer that the patient's blood pressure slightly increased during rapid sequence induction for intubation procedure. Therefore, we do not agree with the conclusion of the authors of the correspondence [[1]] that "in critical care patients, risks vs. benefits of analgesia administration in the pre-intubation phase should be weighed, but the fear of hypotension should not be enough to deprive the patient of adequate analgesia during a painful manoeuvre like tracheal intubation." The physiology of intubation cannot be transferred from the operating room to the ICU since the patients' physiological and pathological conditions are different. [Extracted from the article]

Metabolic acidosis is characterized by a primary reduction in plasma bicarbonate concentration below 20 mmol/L in the Henderson-Hasselbalch method and with either an imbalance between strong plasma cations concentration compared to the strong anions concentration (decreasing thus the strong ion difference) and/or an excess in non-volatile weak acids in the Stewart-Fencl method [[1]]. Metabolic acidemia is observed in 14-42% of the critically ill patients [[7]] and, when acidemia is severe (pH < 7.20) and persists, is associated with 50-60% mortality in the Intensive Care Unit (ICU) [[7]]. The best treatment option to treat metabolic acidosis is the causal treatment which can be very different according to the disease. [Extracted from the article]

Background: Plasma is integral to haemostatic resuscitation after injury, but the timing of administration remains controversial. Anticipating approval of lyophilised plasma by the US Food and Drug Administration, the US Department of Defense funded trials of prehospital plasma resuscitation. We investigated use of prehospital plasma during rapid ground rescue of patients with haemorrhagic shock before arrival at an urban level 1 trauma centre.Methods: The Control of Major Bleeding After Trauma Trial was a pragmatic, randomised, single-centre trial done at the Denver Health Medical Center (DHMC), which houses the paramedic division for Denver city. Consecutive trauma patients in haemorrhagic shock (defined as systolic blood pressure [SBP] ≤70 mm Hg or 71-90 mm Hg plus heart rate ≥108 beats per min) were assessed for eligibility at the scene of the injury by trained paramedics. Eligible patients were randomly assigned to receive plasma or normal saline (control). Randomisation was achieved by preloading all ambulances with sealed coolers at the start of each shift. Coolers were randomly assigned to groups 1:1 in blocks of 20 according to a schedule generated by the research coordinators. If the coolers contained two units of frozen plasma, they were defrosted in the ambulance and the infusion started. If the coolers contained a dummy load of frozen water, this indicated allocation to the control group and saline was infused. The primary endpoint was mortality within 28 days of injury. Analyses were done in the as-treated population and by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01838863.Findings: From April 1, 2014, to March 31, 2017, paramedics randomly assigned 144 patients to study groups. The as-treated analysis included 125 eligible patients, 65 received plasma and 60 received saline. Median age was 33 years (IQR 25-47) and median New Injury Severity Score was 27 (10-38). 70 (56%) patients required blood transfusions within 6 h of injury. The groups were similar at baseline and had similar transport times (plasma group median 19 min [IQR 16-23] vs control 16 min [14-22]). The groups did not differ in mortality at 28 days (15% in the plasma group vs 10% in the control group, p=0·37). In the intention-to-treat analysis, we saw no significant differences between the groups in safety outcomes and adverse events. Due to the consistent lack of differences in the analyses, the study was stopped for futility after 144 of 150 planned enrolments.Interpretation: During rapid ground rescue to an urban level 1 trauma centre, use of prehospital plasma was not associated with survival benefit. Blood products might be beneficial in settings with longer transport times, but the financial burden would not be justified in an urban environment with short distances to mature trauma centres.Funding: US Department of Defense. [ABSTRACT FROM AUTHOR]

In an important sense, support of the respiratory system has been a defining characteristic of intensive care since its inception. The pace of basic and clinical research in this field has escalated over the past two decades, resulting in palpable improvement at the bedside as measured by both efficacy and outcome. As in all medical research, however, novel ideas built upon observations are continually proposed, tested, and either retained or discarded on the basis of the persuasiveness of the evidence. What follows are concise descriptions of the current standards of management practice in respiratory support, the areas of present-day uncertainty, and our suggested agenda for the near future of research aimed at testing current assumptions, probing uncertainties, and solidifying the foundation on which to base our progress to the next level. [ABSTRACT FROM AUTHOR]

Purpose: High-flow nasal cannula oxygen (HFNC) has the potential to provide apnoeic oxygenation. We decided to assess in a proof-of-concept study whether the addition of HFNC to non-invasive ventilation (NIV) could reduce oxygen desaturation during intubation, compared with NIV alone for preoxygenation, in severely hypoxaemic intensive care unit (ICU) patients with respiratory failure.Methods: We conducted a randomised, controlled, single-centre trial with assessor-blinded outcome assessment in patients admitted to the ICU. Hypoxaemic patients requiring orotracheal intubation for respiratory failure were randomised to receive preoxygenation using HFNC [flow = 60 L/min, fraction of inspired oxygen (FiO2) = 100 %] combined with NIV (pressure support = 10 cmH2O, positive end-expiratory pressure = 5 cmH2O, FiO2 = 100 %) in the intervention group or NIV alone in the reference group prior to intubation. The primary outcome was the lowest oxygen saturation (SpO2) during the intubation procedure. Secondary outcomes were intubation-related complications and ICU mortality.Results: Between July 2015 and February 2016, we randomly assigned 25 and 24 patients to the intervention and reference groups, respectively. In both groups the main reasons for respiratory failure were pneumonia and ARDS. During the intubation procedure, the lowest SpO2 values were significantly higher in the intervention group than in the reference group [100 (95-100) % vs. 96 (92-99) %, p = 0.029]. After exclusion of two patients from analysis for protocol violation, no (0 %) patients in the intervention group and five (21 %) patients in the reference group had SpO2 below 80 % (p = 0.050). We recorded no significant difference between the groups in intubation-related complications or ICU mortality.Conclusions: A novel strategy for preoxygenation in hypoxaemic patients, adding HFNC for apnoeic oxygenation to NIV prior to orotracheal intubation, may be more effective in reducing the severity of oxygen desaturation than the reference method using NIV alone. [ABSTRACT FROM AUTHOR]

The article discusses ventilator-induced lung injury (VILI) by referring to a study conducted by researcher Gattinoni and colleagueson energy delivered per unit time in ventilator settings and forces relevant to VILI. Topics discussed include energy conservation law, power or energy load and tidal pressure. Other topics discussed include inspiratory pressure excursion and tissue injury.

An introduction is presented in which the editor discusses the complications associated with administering preoxygenation and high-flow nasal cannulae (HFNC) to critically ill patients in the intensive care unit (ICU).

The article highlights several tips for intensive care management of transplanted liver patients. It includes recommendations for recording of surgical technique and intraoperative events in order to understand the potential complications occurring after the liver transplantation; monitoring of fluid status; and treatment of antibiotic and antifungal prophylaxis.

The authors reflect on the improvements in the field of mechanical ventilation in intensive care unit (ICU) patients. Among the improvements discussed include the increase of adherence to recommendations of ventilator-free days among brain-injured patients, optimized preoxygenation and intubation for brain-injured and non-brain-injured patients, and the interruption of sedation to improve outcomes of critically ill postoperative patients.

Importance: It has not been established whether noninvasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery.Objective: To evaluate whether noninvasive ventilation improves outcomes among patients developing hypoxemic acute respiratory failure after abdominal surgery.Design, Setting, and Participants: Multicenter, randomized, parallel-group clinical trial conducted between May 2013 and September 2014 in 20 French intensive care units among 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure (partial oxygen pressure <60 mm Hg or oxygen saturation [SpO2] ≤90% when breathing room air or <80 mm Hg when breathing 15 L/min of oxygen, plus either [1] a respiratory rate above 30/min or [2] clinical signs suggestive of intense respiratory muscle work and/or labored breathing) if it occurred within 7 days after surgical procedure.Interventions: Patients were randomly assigned to receive standard oxygen therapy (up to 15 L/min to maintain SpO2 of 94% or higher) (n = 145) or NIV delivered via facial mask (inspiratory pressure support level, 5-15 cm H2O; positive end-expiratory pressure, 5-10 cm H2O; fraction of inspired oxygen titrated to maintain SpO2 ≥94%) (n = 148).Main Outcomes and Measures: The primary outcome was tracheal reintubation for any cause within 7 days of randomization. Secondary outcomes were gas exchange, invasive ventilation-free days at day 30, health care-associated infections, and 90-day mortality.Results: Among the 293 patients (mean age, 63.4 [SD, 13.8] years; n=224 men) included in the intention-to-treat analysis, reintubation occurred in 49 of 148 (33.1%) in the NIV group and in 66 of 145 (45.5%) in the standard oxygen therapy group within+ 7 days after randomization (absolute difference, -12.4%; 95% CI, -23.5% to -1.3%; P = .03). Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days; absolute difference, -2.2 days; 95% CI, -0.1 to 4.6 days; P = .04), while fewer patients developed health care-associated infections (43/137 [31.4%] vs 63/128 [49.2%]; absolute difference, -17.8%; 95% CI, -30.2% to -5.4%; P = .003). At 90 days, 22 of 148 patients (14.9%) in the NIV group and 31 of 144 (21.5%) in the standard oxygen therapy group had died (absolute difference, -6.5%; 95% CI, -16.0% to 3.0%; P = .15). There were no significant differences in gas exchange.Conclusions and Relevance: Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting.Trial Registration: clinicaltrials.gov Identifier: NCT01971892. [ABSTRACT FROM AUTHOR]

The authors reflect on the implementation of a quality program in the intensive care unit (ICU) of hospitals worldwide as of October 2015. Also cited are a report by Z. Bo and colleagues in "Intensive Care Medicine" on the clinical outcomes of a comprehensive quality improvement (QI) program in 14 ICUs in China, as well as the importance of QI programs in the implementation of protocols of intubation, sedation analgesia, and prevention of nosocomial infections.

Securing the airway in critical care scenarios - questioning the fundamentals Author's reply We agree that these results cannot be applied to other settings, such as emergency departments, or intubation procedures performed with a video laryngoscope [[5]]. The main objective of the STYLETO study was to assess the effect of a Stylet on successful first-attempt intubation in critically ill patients using a standard Macintosh laryngoscope [[2]]. [Extracted from the article]

Use first video laryngoscope for intubation procedure, if no video laryngoscope available, consider direct Macintosh laryngoscopy with Stylet8. As nicely written by Masuda et al. [[1]], using the Montpellier-intubation-protocol [[3]] first described by Jaber et al. in 2010 (Table 1) may help to decrease intubation-related complications. It is worth noting that a simplified version of the Montpellier-intubation-protocol [[5]] was externally validated by an American team and associated with an improvement in first-pass intubation success rates and a reduction in the rate of intubation-related complications. [Extracted from the article]

The article discusses the use of oxygen therapy in the high-flow nasal cannula (HFNC) following extubation. Research groups have proposed the use of the HFNC as a supportive therapy in critically ill patients with acute respiratory failure. They noted the potential of the HFNC to reduce the degree of atelectasis. It is suggested to further evaluate the HFNC because of the concern over its complications.

The article focuses on the call for papers about perioperative critical care launched by the journal "Intensive Care Medicine."

To provide guidelines for the management of the intensive care patient with severe acute pancreatitis. A consensus committee of 22 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. The most recent SFAR and SNFGE guidelines on the management of the patient with severe pancreatitis were published in 2001. The literature now is sufficient for an update. The committee studied 14 questions within 3 fields. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and the relevant evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. The experts' synthesis work and their application of the GRADE® method resulted in 24 recommendations. Among the formalised recommendations, 8 have high levels of evidence (GRADE 1+/−) and 12 have moderate levels of evidence (GRADE 2+/−). For 4 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any response in the literature. After one round of scoring, strong agreement was reached for all the recommendations. There was strong agreement among experts for 24 recommendations to improve practices for the management of intensive care patients with severe acute pancreatitis. [ABSTRACT FROM AUTHOR]

The article discusses research being done on thoracic surgery procedures and anesthesia. It references the study "Early Postoperative Prophylactic Noninvasive Ventilation After Major Lung Resection in COPD Patients: A Randomized Controlled Trial," by C. Lorut et al. published in the 2013 issue. The researchers investigated the role of systematic postoperative noninvasive ventilation (NIV) in preventing respiratory complications.

Acute respiratory failure is the most common, life-threatening condition in critically ill patients, and is associated with a high morbidity and mortality. Given the importance of mechanical ventilation to ICU care, it is not surprising that over the years, Intensive Care Medicine (ICM) has published many important articles related to acute respiratory failure, acute respiratory distress syndrome (ARDS), and mechanical ventilation. Although COVID-19 will likely be with us for a number of years in one form or another, COVID-19 patients will represent the minority of ICU patients, other than for defined (hopefully very short) periods of time, and thus most of the articles deal with non-COVID-19 acute respiratory failure. [Extracted from the article]

Extubation on vasopressors was controversial until a recent study [[7]] that suggested that extubation on low-dose vasopressors ( 0.1 g/kg/min) could be safe and associated with a lower mortality and a shorter ICU length of stay. In a recent randomized trial of patients receiving mechanical ventilation [[3]], a 30-min PSV-SBT resulted in a significantly higher rate of successful extubation than a 2-h T-piece SBT, without significantly increasing reintubation. To anticipate airway failure before extubation, cough expiratory peak-flow and the evaluation of the amount of secretions are also important to identify patients at risk to develop airway failure. Extubation failure, defined as the inability to sustain spontaneous breathing after removal of the artificial airway and need for reintubation within 24-72 h or up to 7 days, is associated with high morbidity and mortality, as well as long term disability [[1]]. [Extracted from the article]

To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit (ICU). Two-phase, prospective, multicenter controlled study. Three medical-surgical ICUs in two university hospitals. Two hundred three consecutive ICU patients required 244 intubations. All intubations performed during two consecutive phases (a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol) were evaluated. The ten bundle components were: preoxygenation with noninvasive positive pressure ventilation, presence of two operators, rapid sequence induction, cricoid pressure, capnography, protective ventilation, fluid loading, preparation and early administration of sedation and vasopressor use if needed. The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation (cardiac arrest or death, severe cardiovascular collapse and hypoxemia). Other complications (mild to moderate) were also evaluated. Baseline characteristics, including demographic data and reason for intubation (mainly acute respiratory failure), were similar in the two phases. The intubation procedure in the intervention phase ( n = 121) was associated with significant decreases in both life-threatening complications (21 vs. 34%, p = 0.03) and other complications (9 vs. 21%, p = 0.01) compared to the control phase ( n = 123). The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients. [ABSTRACT FROM AUTHOR]

The article discusses on Noninvasive Ventilation (NIV) as a tool for mitigation of respiratory conditions including postoperative hypoxemia and acute respiratory failure. Recent studies claim that increased mortality caused by pulmonary conditions is brought by complications that spring from invasive treatments specifically reintubation and mechanical ventilation. It discusses that the roles of NIV are focused primarily on facilitation of breathing, improving alveolar ventilation and reduction of atelectasis. NIV function serves to reduce nosocomial infections and morbidity and mortality of patients diagnosed with acute respiratory failure who undergone thoracic and abdominal surgery. It notes that professional NIV application can produce good outcome in intensive care unit patients.

The article discusses the developments in mechanical ventilation of patients without acute respiratory distress syndrome (ARDS). The author details that the report of decreasing number of ARDS is due to new medical advancements and treatment of the disease and highlights the risks of artificial respiration on patients without ARDS. Also presented is the clinical findings of the positive effects of protective ventilation in patients without ARDS.

The article presents a study which compares adaptive support ventilation (ASV) to adaptive pressure ventilation (APV) and to pressure support ventilation (PSV) in mechanically ventilated patients whose respiratory demand was artificially increased. The authors evaluated arterial blood gases, ventilator response and patient respiratory effort parameters at the end of the six periods. It was observed that adding dead space significantly increased minute ventilation, and ASV and PSV showed comparable responses when facing changes in ventilatory demand by contrast to APV.

A letter to the editor is presented in response to the article "Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis" by F. M. Brunkhorst, C. Engel and F. Bloos in the January 10, 2008 issue.

In the hypothesis where the number of patients requiring invasive mechanical ventilation would exceed the present capacities and availability of ventilators in French health care facilities, the possibility of employing a single ventilator to ventilate several patients has recently been suggested. Ventilating a patient with ARDS may be challenging, attempting to ventilate several patients on a single ventilator could expose all patients to an increased risk of complications or even increased mortality. [Extracted from the article]

Background:Patients with acute pancreatitis (AP) who require mechanical ventilation have high morbidity and mortality rates. Noninvasive positive pressure ventilation (NPPV) delivered through a mask has become increasingly popular for the treatment of acute respiratory failure (ARF) and may limit some mechanical ventilation complications. Objectives: The purpose of this retrospective, observational study was to evaluate our clinical experience with the use of NPPV in AP patients with ARF. Methods: From 1997 to 2003, we documented clinical data, gas exchange and outcome of the 62 AP patients admitted to our intensive care unit. Patients who benefited from NPPV (success) were compared with those who failed (intubated). Results:Twenty-nine patients were intubated at admission and 5 did not develop ARF. Of the 28 patients treated with NPPV, 15 were not intubated (54%). Both groups had a similar PaO2/FiO2 ratio (142 ± 21 vs. 133 ± 20; p = 0.127) and severity of illness (Ranson and Balthazar scores). Presence of atelectasis, bilateral alveolar infiltrates and abdominal distension were associated with failure of NPPV. Oxygenation improved and respiratory rate decreased significantly only in the success group. Additionally, the length of stay at the intensive care unit was significantly lower in the success group. Conclusion: NPPV is feasible and safe to treat ARF in selected patients with AP who require ventilatory support. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Prolonged controlled mechanical ventilation (MV) is known to induce diaphragmatic oxidative stress that seems to be an important factor reducing force-generating capacity. To better understand the cellular mechanisms involved, this work examined the effect of short vs. prolonged MV on antioxidant defense in the diaphragm.Design and Setting: Prospective, randomized, controlled animal study in a university laboratory.Methods: Eleven piglets (15-20 kg) were assigned to one of two groups: a long-MV group (n=6) ventilated for 3 days or a short-MV group (n=5) ventilated for 3 h. Force frequency curves of the transdiaphragmatic pressure (Pdi) were obtained in vivo by phrenic nerve pacing. Oxidative stress was evaluated by thiobarbituric reactive substance (TBARs) content and the enzymatic antioxidant activity of both superoxide dismutase (SOD) and glutathione peroxidase (GPx) in samples of diaphragm.Results: Pdi decreased in the long-MV group by 30-35% over the 3 days at all frequencies compared to the short-MV group. Diaphragm TBARs content was significantly higher and SOD activity lower in long-MV animals than in short-MV animals after 72 h. GPx activity tended to be lower in diaphragms from long-MV animals, but this difference was not significant.Conclusions: This study shows that 3 days of MV in piglets is associated with a decrease in antioxidant activity which could emphasize oxidative stress and both contribute to the diaphragm dysfunction caused by MV. [ABSTRACT FROM AUTHOR]

Presents information about a study which evaluated the incidence, risks factors, and outcomes of agitation in intensive care unit (ICU). Information about design of the study; Comments on the findings of the study which indicate that agitation is a common event in a mixed medical-surgical ICU; Association of agitation with adverse outcomes including prolonged stay, nosocomial infections, and unplanned extubations.

This article focuses on a study related to evaluation of the clinical experience with the use of noninvasive positive pressure ventilation (NPPV) in the treatment of acute respiratory failure (ARF) after abdominal surgery. NPPV should be considered as an interesting alternative to conventional ventilation in selected patients after abdominal surgery with ARF who require ventilatory support. The role of NPPV in the treatment of hypoxemic ARF is recognized and becoming more widespread. The results of this descriptive study can be the basis for a larger, prospective, randomized study comparing NPPV with conventional medical treatment.

Objective: To compare volume support ventilation (VSV) in which the pressure support level is continuously adjusted to deliver a preset tidal volume, with pressure support ventilation (PSV), in terms of patient behavior and ventilator response when ventilatory demand was increased by addition of dead space to the circuit.Design and Setting: Randomized cross-over study in an intensive care unit university hospital.Interventions: We assessed in ten patients being weaned off mechanical ventilation the effect of increasing the ventilatory demand by adding a heat-and-moisture exchanger to augment the dead space with a fixed level of PSV and VSV.Measurements and Results: Arterial blood gases, breathing pattern, and respiratory effort parameters at the end of each of the four steps. Adding dead space significantly increased minute ventilation and PaCO2 values with both PSV and VSV. Indexes of respiratory effort (pressure-time index of respiratory muscles and work of breathing) increased with both ventilatory modes after dead-space augmentation. This increase was 2.5-4 times with VSV than with PSV and induced overt respiratory distress in two patients. The assistance delivered during VSV decreased significantly after dead-space augmentation, from 15.0+/-6.5 to 9.1+/-4.8 cmH2O, whereas no change occurred with PSV.Conclusions: With a fixed level of VSV, but not of PSV, an increase in ventilatory demand results in a decrease in the pressure support provided by the ventilator, opposite to the desired response. VSV may conceivably result in respiratory distress in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence, associated findings, and consequences of cytomegalo- virus (CMV) antigenemia in critically ill patients. Design: A retrospective, case-control clinical study. Setting: A 12-bed university hospital medical-surgical ICU. Patients: Two hundred thirty-seven patients with fever for > 72 h, without proven evidence of bacteriologic and/or fungal origin, and whose pp65 antigenemia assays were studied. Patients with HIV infection and transplant recipients were excluded. Interventions: None. Measurements and results: CMV antigenemia was diagnosed within 20 ± 12 days (mean ± SD) after ICU admission in 11% patients in whom the pathology was suspected. The 40 patients in the CMV group were matched with 40 other patients in the control group. CMV infection was linked to renal failure (58% vs 33%, respectively; p = 0.02) and steroid use (55% vs 33%, respectively; p = 0.04). Patients with CMV had a significantly longer stay in the ICU (41 ± 28 days vs 31 ± 22 days, respectively; p = 0.04), a longer duration of mechanical ventilation (35 ± 27 days vs 24 ± 20 days, respectively; p = 0.03), a higher rate of nosocomial infection (75% vs 50%, respectively; p = 0.04), and a higher mortality (50% vs 28%, p = 0.02). Conclusions: CMV antigenemia is not an uncommon diagnosis in critically ill ICU patients with unexplained prolonged fever after 10 days of hospitalization, regardless of their immune system status. Although associated with a higher morbidity and mortality, the clinical significance of CMV is unknown. Further prospective studies should evaluate the impact on ICU outcome and whether CMV is truly a pathogen or simply another indicator of immunosuppression. [ABSTRACT FROM AUTHOR]

A 55-year-old male presented with a nine-month history of gradually enlarging, painless mass in the right external auditory canal associated with hearing loss and occasional bleeding. Examination demonstrated complete obstruction of the outer 1/3 of the external auditory canal by a firm, pink, rubbery mass. CT scan of the temporal bone showed tumor mass with no evidence of bone destruction. The tumor was excised and histopathology confirmed a diagnosis of ceruminous pleomorphic adenoma of the external auditory canal. Six months following the surgery, patient is free of any recurrent disease. [ABSTRACT FROM AUTHOR]

The article discusses the potential benefits and risks of using artificial intelligence (AI) in scientific publishing and the peer review process. It acknowledges that AI can offer various opportunities to support editors, reviewers, authors, and the scientific community, such as formatting checks, conflict of interest assessments, and copyediting. However, the authors emphasize the need for caution and an ethically focused approach to mitigate potential negative impacts. They also highlight the importance of specific and specialized AI models for scientific publishing and the need to address challenges and errors associated with AI implementation. The article concludes by mentioning the policies of Springer Nature, which aim to minimize harm, ensure privacy and data governance, and prioritize dignity and respect. [Extracted from the article]

The authors discuss the results of a quality improvement project about reducing deep sedation and coma in mechanically ventilated patients in an intensive care unit (ICU). The article mentions that some ICU patients with acute lung injury or acute respiratory distress syndrome (ARDS) were selected for the project. This study indicated the possibility of lightening sedation in some critically ill patients by decreasing the occurrence of coma and delirium without increasing pain.

A letter to the editor is presented entitled "Use of recombinant human activated protein C in patients with severe sepsis: a French retrospective multicentre study," published within the issue.