OBJECTIVE Improved respiratory outcome has been shown after selective pulsatile pulmonary perfusion (sPPP) during cardiopulmonary bypass (CPB). No contemporary study has analysed the impact of sPPP on alveolar and systemic inflammatory response in humans. METHODS Sixty-four patients undergoing a coronary artery bypass graft (CABG) were randomized to sPPP or standard CPB (32 patients each). An...

Complications associated with mechanical ventilation have been extensively described in the literature in the last 3 decades.1 From ventilator-induced lung injury to ventilator-induced diaphragmatic dysfunction more recently defined, numerous side effects directly or indirectly related to mechanical ventilation have been identified. As a consequence, so-called lung-protective ventilation could ...

I refer to the article published in CHEST (June 2007) by Fremont et al 1 describing the hydrostatic mechanism for postobstructive pulmonary edema. This theory only explains the situation in which acute obstruction occurs after extubation (eg, acute laryngospasm), but does not explain conditions with chronic upper airway obstruction. We came across a case of postextubation pulmonary edema that c...

BACKGROUND Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness, and blood-streaked expectorant. In this study, we investigated the short-term (hours) impact of measuring and controlling endotracheal tube cuff (ETTc) pressure on postprocedural complications. METHODS Five hundred nine patients from 4 tertiary care universi...

IMPORTANCE Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. OBJECTIVE To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial cond...

To the Editor: In the March 2013 issue of ANESTHESIOLOGY, Dr. Ahn et al.1 present a thorough and informative review of pain-associated respiratory failure. The review is based on a case report describing a 79-yr-old man with bilateral chest trauma, in whom the treating team decided to use epidural analgesia. This is not an uncommon scenario; however in this case, the patient was taking clopidog...

provided the original work is properly cited. CC A drastic, progressive gangrenous cellulitis of the soft tissues of the deep neck and mouth floor was described in 1836 by the German surgeon Karl Friedrich Wilhelm von Ludwig [1]. Current medical care practices have meant that Ludwig’s angina is rarely seen. However, once the disease process is underway, there is a serious risk of sudden death d...

Noninvasive ventilation (NIV) represents the standard of care in acute respiratory failure.1 In acute hypercapnic ventilatory failure due to COPD exacerbations and acute cardiogenic pulmonary edema, NIV is without doubt highly effective in terms of reduced intubation rates and mortality.2,3 As a consequence of the growing amount of evidence for these benefits, NIV use has been ever increasing d...

Why does a study about the use of noninvasive ventilation (NIV) and helium-oxygen mixtures in pulmonary rehabilitation call to mind a movie about World War II? Released in 1949, Twelve O’Clock High was based on a fictionalized version of the experiences of a writer who had served under Brigadier General Frank Savage, the officer responsible for implementing the use of precision daylight bombing...

Apart from the clinical conditions that require immediate ventilator support, conventional oxygen therapy (COT) via a face mask or nasal cannula is considered the “firststep approach” in the escalating therapy for the management of acute respiratory failure (ARF) to buy time for the etiologic therapy to reverse the triggering cause of the acute decompensation.1 Once physicians realize that only...