Combining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: the Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study.

Objective: To determine the safety, feasibility, and lung-recruitment efficacy of an explicit ventilation protocol combining high-frequency oscillatory ventilation and recruitment maneuvers.

Design: Prospective, multiple-center, single-intervention pilot study.

Setting: Four university-affiliated intensive care units.

Nursing and infection-control issues during high-frequency oscillatory ventilation.

Objectives: To review the specific nursing and infection-control issues that arise during the care of patients receiving high-frequency oscillatory ventilation (HFOV).

Data Source: Published articles, governmental guidelines, and hospital procedures and practices.

Data Summary: Nurses, respiratory therapists, and other clinicians caring for patients receiving HFOV need to be aware of specific differences in patient assessment, including close observation for symmetric chest-wall vibrations.

Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome.

Objective: To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality.

Design: Subanalysis of a prospective observational study. Multivariable logistic regression was used to analyze the effects of ventilatory management on mortality.

Pro/con clinical debate: tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment.

Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. Although tracheostomies are increasingly common procedures, they are not without complications and costs, and hence a decision to perform them should not be taken lightly.

Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.

Background: The American-European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated.

Objective: To compare clinical criteria for ARDS with autopsy findings.

Design: Independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records.

Noninvasive positive-pressure ventilation for respiratory failure after extubation.

Background: The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive-pressure ventilation has been suggested as a promising therapy for patients with respiratory failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting.

Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial.

Objectives: The American-European consensus conference (AECC) definition for acute respiratory distress syndrome (ARDS) requires a PaO(2)/F(I)O(2)< or =200 mmHg, regardless of ventilator settings. We report the results of using standardized ventilator settings to screen and enroll ARDS patients in a clinical trial of high-frequency oscillatory ventilation (HFOV), including the impact on study enrollment, and potential effects on study outcome.

Design: Prospective cohort study.

High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome.

Objective: To determine the incidence and severity of pulmonary artery wedge pressure (PAWP) elevation in patients with ALI/ARDS. In addition, to examine the effects of clinical variables on the presence of a high PAWP (>18 mmHg) and the effect of an elevated PAWP on mortality.

Design And Patients: Post hoc analysis of 120 patients with or at high risk of ARDS, enrolled in a randomized controlled trial of pressure- and volume-limited ventilation.

A Minimally Invasive Approach to the Management of Bronchial Carcinoid Tumors Associated with Ectopic Cushing's Syndrome.

Cushing's Syndrome is usually the result of a pituitary corticotroph or an adrenocortical adenoma. Rarely, an ectopic carcinoid tumor can elaborate sufficient amounts of adrenocorticotropic hormone (ACTH) to result in cortisol excess and Cushing's Syndrome. The diagnosis and management of these unusual neoplasms remains problematic.

New therapies for adults with acute lung injury. High-frequency oscillatory ventilation.

High-frequency oscillatory ventilation seems theoretically ideal for the treatment of patients with ARDS, allowing adequate oxygenation and ventilation to be maintained without causing further damage to the already injured lung. High-frequency oscillating ventilation also seems a sound strategy for improving oxygenation in patients who are no longer responding to conventional mechanical ventilation. Currently, HFOV should be used in the adult ICU as one of many ancillary therapies available for the treatment of extremely ill, hypoxemic patients with ARDS.