tailieunhanh - Báo cáo y học: "Recently published papers: a little less ventilation, a little more oxygen please"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recently published papers: a little less ventilation, a little more oxygen please? | Available online http content 12 3 152 Commentary Recently published papers a little less ventilation a little more oxygen please Jonathan Ball General Intensive Care Unit St George s Hospital London SW17 0QT UK Corresponding author Jonathan Ball jball@ Published 27 May 2008 This article is online at http content 12 3 152 2008 BioMed Central Ltd Critical Care 2008 12 152 doi cc6898 Abstract Recent papers discussed include two large multicentre highpositive end-expiratory pressure trials in acute lung injury and reflects upon the usefulness of such trial designs. Further papers considered include the emerging story of P2-agonists for pulmonary oedema highlights the newly described iatrogenic demon of ventilator-induced diaphragm injury promotes the addition of B-type natriuretic peptide testing to the prediction of extubation success and muses again over the oxygen debate. Emerging clarity in setting positive end-expiratory pressure Minimising ventilator-induced lung injury while providing optimal respiratory support remains challenging. Limiting tidal volumes to 6 ml kg predicted body weight has been widely adopted in theory at least but numerous other debates remain - perhaps most contentiously - regarding positive end-expiratory pressure PEEP . Two large trials investigating the optimal ventilatory approach to patients with acute lung injury have recently been published. In the first a combined Canadian Australian and Saudi Arabian multicentre study 983 patients were randomised to a 6 ml kg predicted body weight tidal volume with either established ARDSnet PEEP settings or a high PEEP strategy with recruitment manoeuvres 1 . Of note plateau pressures in the lower PEEP group were limited to 30 cmH2O whilst those in the high-PEEP group were limited to 40 cmH2O. The protocol produced a significantly higher average PEEP in the experimental group with consequently higher plateau pressures. There was no difference between the .

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