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BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because(More)
CONTEXT The need for lung protection is universally accepted, but the optimal level of positive end-expiratory pressure (PEEP) in patients with acute lung injury (ALI) or acute respiratory distress syndrome remains debated. OBJECTIVE To compare the effect on outcome of a strategy for setting PEEP aimed at increasing alveolar recruitment while limiting(More)
BACKGROUND Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia. METHODS We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had(More)
CONTEXT Trials comparing higher vs lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) have been underpowered to detect small but potentially important effects on mortality or to explore subgroup differences. OBJECTIVES To evaluate the association of higher vs lower PEEP(More)
BACKGROUND Diaphragmatic muscle contractions triggered by ventilator insuffl ations constitute a form of patient-ventilator interaction referred to as “entrainment,” which is usually unrecognized in critically ill patients. Our objective was to review tracings, which also included muscular activity, obtained in sedated patients who were mechanically(More)
The use of ultrasonography has become increasingly popular in the everyday management of critically ill patients. It has been demonstrated to be a safe and handy bedside tool that allows rapid hemodynamic assessment and visualization of the thoracic, abdominal and major vessels structures. More recently, M-mode ultrasonography has been used in the(More)
BACKGROUND Prolonged immobilization may harm intensive care unit (ICU) patients, and early mobilization has been proposed to counteract that process. We describe our experience in early rehabilitation of ICU patients, and its effects on physiologic outcomes. METHODS We included all patients who stayed in our 14-bed medical ICU for > or = 7 days and(More)
PURPOSE The aim of the present study was to assess the rate of diffuse alveolar damage (DAD) on open lung biopsy (OLB) performed in the ICU for nonresolving ARDS. METHODS A single-center retrospective study of patients meeting the Berlin definition criteria for ARDS who had undergone OLB for nonresolving ARDS. Patients were classified into mild, moderate(More)
OBJECTIVE To evaluate a new approach for monitoring and improving patient-ventilator interaction that utilizes a signal generated by the equation of motion, using improvised values for resistance and elastance obtained noninvasively. DESIGN AND SETTING Observational study in intensive care units in five European centers. PATIENTS We studied 21 stable(More)
The day of extubation is a critical time during an intensive care unit (ICU) stay. Extubation is usually decided after a weaning readiness test involving spontaneous breathing on a T-piece or low levels of ventilatory assist. Extubation failure occurs in 10 to 20% of patients and is associated with extremely poor outcomes, including high mortality rates of(More)