ABSTRACT: Background:Low-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of possitive end-expiratory pressure (PEEP) is intended to keep the alveoli open. No method of adjusting the optimal PEEP level has shown to be superior and improve clinical outcomes.We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at highest compliance on oxygenation, multiple organ disfunction (MOD) and survival in patients with the acute respiratory distress syndrome (ARDS).Methods:Patients with ARDS ventilated with low tidal volumes and limitation of airway pressure at 30 cmH(2)O were randomized to a compliance-guided PEEP level or to an FiO(2)-driven study group.Results:Out of 159 patients with ARDS admitted during the study period, 70 patients met inclusion criteria for the present study. Patients in the compliance-guided group showed non-significant improvements in PaO(2)/FiO(2) ratio during the first 14 days and 28-day mortality (20.6% vs. 38.9%, p=0.12). MOD-free days (median 6 vs. 20, p=0.02), respiratory failure-free days (median 7 vs. 14, p=0.03) and hemodynamic failure-free days (median 16 vs. 22, p=0.04) at 28 days were significantly lower in patients with compliance-guided setting of PEEP level.Conclusions:In ARDS patients, protective mechanical ventilation with PEEP application according to the highest compliance is associated with less organ dysfunction and a strong non-significant trend toward lower mortality.
Respiratory care 01/2013; · 2.01 Impact Factor
European Journal of Internal Medicine 11/2008; 19(6):e38-9. · 2.00 Impact Factor
ABSTRACT: Iseganan, an antimicrobial peptide, is active against aerobic and anaerobic gram-positive and gram-negative bacteria as well as fungi and yeasts. The drug has shown little resistance in vitro and to be safe and well tolerated in 800 patients with cancer treated for up to 6 wk.
To determine the efficacy of iseganan for the prevention of ventilator-associated pneumonia (VAP).
Mechanically ventilated patients in the United States and Europe were randomized to oral topical iseganan or placebo (1:1) and treated six times per day while intubated for up to 14 d. Patients were eligible if randomized within 24 h of intubation and estimated to survive and remain mechanically ventilated for 48 h or more. The primary efficacy endpoint of the study was VAP measured among survivors at Day 14.
A total of 709 patients were randomized and received at least one dose of study drug. The two groups were comparable at baseline except iseganan-treated patients were, on average, 3 yr older. The rate of VAP among survivors at Day 14 was 16% (45/282) in patients treated with iseganan and 20% (57/284) in those treated with placebo (p = 0.145). Mortality at Day 14 was 22.1% (80/362) in the iseganan group compared with 18.2% (63/347) in the placebo group (p = 0.206). No pattern of excess adverse events in the iseganan group compared with placebo was observed.
Iseganan is not effective in improving outcome in patients on prolonged mechanical ventilation.
American Journal of Respiratory and Critical Care Medicine 02/2006; 173(1):91-7. · 11.08 Impact Factor
ABSTRACT: Noninvasive mechanical ventilation (NIMV) is beneficial for patients with acute respiratory failure (ARF) when added to medical treatment. However, its role as an alternative to conventional mechanical ventilation (CMV) remains controversial. Our aim was to compare the efficacy and resource consumption of NIMV against CMV in patients with ARF.
A randomized, multicenter, controlled trial.
Seven multipurpose ICUs.
Sixty-four patients with ARF from various causes who fulfilled criteria for mechanical ventilation.
The noninvasive group received ventilation through a face mask in pressure-support mode plus positive end-expiratory pressure; the conventional group received ventilation through a tracheal tube.
Avoidance of intubation, mortality, and consumption of resources were the outcome variables. Thirty-one patients were assigned to the noninvasive group, and 33 were assigned to the conventional group. In the noninvasive group, 58% patients were intubated, vs 100% in the conventional group (relative risk reduction, 43%; p < 0.001). Stratification by type of ARF gave similar results. In the ICU, death occurred in 23% and 39% (p = 0.09) and complications occurred in 52% and 70% (p = 0.07) in the noninvasive and conventional groups, respectively. There were no differences in length of stay. The Therapeutic Intervention Score System-28, but not the direct nursing activity time, was lower in the noninvasive group during the first 3 days.
NIMV reduces the need for intubation and therapeutic intervention in patients with ARF from different causes. There is a nonsignificant trend of reduction in ICUs and hospital mortality together with fewer complications during ICU stay.
Chest 12/2005; 128(6):3916-24. · 5.25 Impact Factor