BACKGROUND Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. AIM The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. MATERIALS AND...

OBJECTIVE To compare dexmedetomidine vs. placebo with respect to the amount of additional propofol and morphine used for bispectral index-guided sedation and analgesia in mechanically ventilated, intensive care patients after surgery. DESIGN Prospective, randomized, double blind, placebo-controlled, phase II clinical trial. SETTING General surgical and cardiac surgical intensive care units....

OBJECTIVES A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and ...

We read with interest the recent Critical Care review of post-extubation laryngeal edema and stridor resulting in respiratory failure [1]. We mostly agree with the authors’ opinion in that article except that the cuff leak test (CLT) was proposed as a standard extubation algorithm. We have two reasons to disagree. First, although the CLT has been widely used for the prediction of post-extubatio...

BACKGROUND A substantial proportion of patients with neuromuscular disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) c...

INTRODUCTION Over 18 000 children are admitted annually to UK paediatric intensive care units (PICUs), of whom nearly 75% receive respiratory support (invasive and/or non-invasive). Continuous positive airway pressure (CPAP) has traditionally been used to provide first-line non-invasive respiratory support (NRS) in PICUs; however, high-flow nasal cannula therapy (HFNC), a novel mode of NRS, has...

(as characterized by low pH, persisting tachypnea, hypoxemia, etc). Other minor questions about the guidelines regarding the exclusion of certain patients can be raised. For example, patients with pneumothoraces are excluded, with no provision for inclusion once appropriate drainage has been instituted. Also, patients with upper airway obstruction were excluded, yet a historically controlled tr...

The development and implementation of clinical practice guidelines have been shown to improve patient care and outcomes and have been well described for over 2 decades. Although there are a myriad of terms such as pathways, protocols, care maps, and bundles, the fundamental aim is the same: evidence from clinical trials and associated research informs clinicians of best approaches for the deliv...

POSTOPERATIVE hypoxemia and/or acute respiratory failure (ARF) mainly develop after abdominal and/or thoracic surgery. Anesthesia, postoperative pain, and surgery will induce respiratory modifications: hypoxemia, decrease in pulmonary volume, and atelectasis associated with a restrictive syndrome and a diaphragm dysfunction. These modifications of the respiratory function occur early after surg...

a study published in the previous issue of Critical Care, Gonçalves and colleagues [1] observed a 33% reduction in re-intubation rate in the study group, due to eff ective management of bronchial secretions. Current evidence favors early implementation of noninvasive mechanical ventilation (NIV) in the post-extubation period to reduce re-intubation, especially in patients with hypercapnic respi...