BACKGROUND Aerosolized iloprost, an inhaled synthetic analogue of prostacyclin, is an approved therapy for stage III and IV pulmonary hypertension. However, currently iloprost is delivered via a device that requires a clinically stable patient who can use a hand-held nebulizer. We designed separate aerosol delivery systems to nebulize iloprost to critically ill patients during (1) mechanical ve...

spontaneous breathing as soon as possible 2 and lowpressure suction of the chest tubes after operation are critical.2, 3 Some ventilatory support is necessary, however, when a patient continues to have hypoventilation after operation. Pressure-controlled ventilation rather than volume-controlled ventilation has been recommended for such patients because it can deliver high inspired gas flows in...

Questions: In adults with an acute exacerbation of chronic obstructive pulmonary disease (COPD) receiving non-invasive positive pressure ventilation (NIV), is intrapulmonary percussive ventilation (IPV) feasible? Does IPV improve outcomes compared to manual airway clearance techniques? Design: Randomised, controlled trial with concealed allocation. Setting: Intensive care unit of a tertiary hos...

We identified 16 randomized controlled trials (RCTs) of methods for weaning patients from mechanical ventilation, 8 of which were trials of discontinuation assessment strategies, 5 of which were trials of stepwise reduction in mechanical ventilatory support, and 3 of which were trials comparing alternative ventilation modes for weaning periods lasting < 48 h. We found that different thresholds ...

BACKGROUND Patients undergoing complex head and neck free flap reconstructions are commonly maintained on mechanical ventilation in an intensive care unit (ICU). This study reviews indications and outcomes of such patients undergoing a rapid awakening protocol (RAP). METHODS We retrospectively reviewed consecutive patients who underwent head and neck microvascular reconstructions by a single ...

Questions: In adults with an acute exacerbation of chronic obstructive pulmonary disease (COPD) receiving non-invasive positive pressure ventilation (NIV), is intrapulmonary percussive ventilation (IPV) feasible? Does IPV improve outcomes compared to manual airway clearance techniques? Design: Randomised, controlled trial with concealed allocation. Setting: Intensive care unit of a tertiary hos...

Introduction Is There a Role for Screening Spirometry? Are Corticosteroids Useful in Late-Stage Acute Respiratory Distress Syndrome? Should Patients Be Able to Follow Commands Prior to Extubation? Are Sleep Studies Appropriately Done in the Home? Should Tracheostomy Be Performed as Early as 72 Hours in Patients Requiring Prolonged Mechanical Ventilation? Should Prone Positioning Be Routinely Us...

BACKGROUND AND OBJECTIVES We investigated the effect of different breathing aids on ventilation distribution in healthy adults and subjects with cystic fibrosis (CF). METHODS In 11 healthy adults and 9 adults with CF electrical impedance tomography measurements were performed during spontaneous breathing, continuous positive airway pressure (CPAP) and positive expiratory pressure (PEP) therap...

BACKGROUND Previous studies indicate that anesthesia and surgery induce an inflammatory reaction in alveolar macro phages. However,they filed to independently evaluate the relative contributions of factors including mechanical ventilation, general anesthesia, and surgical stress. Therefore, the authors tested the hypothesis that inflammatory reactions at the cellular level in alveolar macrophag...

Since the early 1970s there has been an ongoing debate regarding the wisdom of promoting unassisted spontaneous breathing throughout the course of critical illness in patients with severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. Historically, the term "disuse atrophy" has described a situation wherein sustained inactivity of the r...