In patients with established acute respiratory distress syndrome, open lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma. This pilot study supports the need for a large, multicenter trial using recruitment maneuvers and a decremental positive end-expiratory pressure trial in persistent acute respiratory distress syndrome.

On the basis of current evidence, and despite the order of magnitude of reported European and USA incidence figures, it seems that the incidence and overall mortality of ARDS has not changed substantially since the original ARDSnet study. The current mortality of adult ARDS is still greater than 40%.

Cuff leakage varies greatly among ETT types and is affected by cuff pressure, PEEP, PIP, and mode.

Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P¼0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P¼0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P¼0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09e1.90; P¼0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89e1.90; P¼0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. Clinical trial registration: NCT01601223.

BACKGROUND: Maintaining endotracheal tube cuff pressure within a narrow range is an important factor in patient care. The goal of this study was to evaluate the IntelliCuff against the manual technique for maintaining cuff pressure during simulated mechanical ventilation with and without movement. METHODS: The IntelliCuff was compared to the manual technique of a manometer and syringe. Two independent studies were performed during mechanical ventilation: part 1, a 2-h trial incorporating continuous mannikin head movement; and part 2, an 8-h trial using a stationary trachea model. We set cuff pressure to 25 cm H 2 O, PEEP to 10 cm H 2 O, and peak inspiratory pressures to 20, 30, and 40 cm H 2 O. Clinical importance was defined as both statistically significant (P < .05) and clinically significant (pressure change [⌬] > 10%). RESULTS: In part 1, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P < .001, ⌬ ‫؍‬ ؊39.6%) but not for the IntelliCuff (P ‫؍‬ .02, ⌬ ‫؍‬ 3.5%). In part 2, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P ‫؍‬ .004, ⌬ ‫؍‬ ؊14.39%) but not for the IntelliCuff (P ‫؍‬ .20, ⌬ ‫؍‬ 5.65%). CONCLUSIONS: There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures.

The PROVHILO trial, including this substudy, was registered at clinicaltrials.gov (NCT01441791).

No abstract

During VA/C, tidal volume was set at 500 mL and inspiratory time was set at 0.8 second. Rise time and termination criteria were set at the manufacturers' defaults, and to an optimal level during PS and PA/C. RESULTS: There were marked differences in ventilator performance in all 3 modes. VA/C had the greatest difficulty meeting lung model demand and the greatest variability across all tested scenarios and ventilators. From high to low inspiratory muscle effort, pressure-to-trigger, time for pressure to return to baseline, and triggering pressuretime product decreased in all modes. With increasing resistance and decreasing compliance, tidal volume, pressure-to-trigger, time-to-trigger, time for pressure to return to baseline, time to 90% of peak pressure, and pressure-time product decreased. There were large differences between the default and optimal settings for all the variables in PS and PA/C. Performance was not affected by PEEP. CONCLUSIONS: Most of the tested ventilators performed at an acceptable level during the majority of evaluations, but some ventilators performed inadequately during specific settings. Bedside clinical evaluation is needed. Key words: ventilator; mechanical ventilation; intensive care; pressure support; pressure assist/control; volume assist/control. [Respir Care 2011;56(7):928 -940.