We found that ΔP was the ventilation variable that best stratified risk. Decreases in ΔP owing to changes in ventilator settings were strongly associated with increased survival. (Funded by Fundação de Amparo e Pesquisa do Estado de São Paulo and others.).

No abstract

A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world's population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders—policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI.Additional co-authors: Endre Czeiter, Marek Czosnyka, Ramon Diaz-Arrastia, Jens P Dreier, Ann-Christine Duhaime, Ari Ercole, Thomas A van Essen, Valery L Feigin, Guoyi Gao, Joseph Giacino, Laura E Gonzalez-Lara, Russell L Gruen, Deepak Gupta, Jed A Hartings, Sean Hill, Ji-yao Jiang, Naomi Ketharanathan, Erwin J O Kompanje, Linda Lanyon, Steven Laureys, Fiona Lecky, Harvey Levin, Hester F Lingsma, Marc Maegele, Marek Majdan, Geoffrey Manley, Jill Marsteller, Luciana Mascia, Charles McFadyen, Stefania Mondello, Virginia Newcombe, Aarno Palotie, Paul M Parizel, Wilco Peul, James Piercy, Suzanne Polinder, Louis Puybasset, Todd E Rasmussen, Rolf Rossaint, Peter Smielewski, Jeannette Söderberg, Simon J Stanworth, Murray B Stein, Nicole von Steinbüchel, William Stewart, Ewout W Steyerberg, Nino Stocchetti, Anneliese Synnot, Braden Te Ao, Olli Tenovuo, Alice Theadom, Dick Tibboel, Walter Videtta, Kevin K W Wang, W Huw Williams, Kristine Yaffe for the InTBIR Participants and Investigator

The panel formulated and provided the rationale for recommendations on selected ventilatory interventions for adult patients with ARDS. Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline.

Survey research is an important form of scientific inquiry 1 that merits rigorous design and analysis. 2 The aim of a survey is to gather reliable and unbiased data from a representative sample of respondents.3 Increasingly, investigators administer questionnaires to clinicians about their knowledge, attitudes and practice 2,4,5 to generate or refine research questions and to evaluate the impact of clinical research on practice. Questionnaires can be descriptive (reporting factual data) or explanatory (drawing inferences between constructs or concepts) and can explore several constructs at a time. Questionnaires can be informal, conducted as preparatory work for future studies, or formal, with specific objectives and outcomes.Rigorous questionnaires can be challenging and labour-intensive to develop, test and administer without the help of a systematic approach. 5 In this article, we outline steps to design, develop, test and administer valid questionnaires with minimal bias and optimal response rates. We focus on selfadministered postal and electronic surveys of clinicians that are amenable to quantitative analysis. We highlight differences between postal and electronic administration of surveys and review strategies that enhance response rates and reporting transparency. Although intended to assist in the conduct of rigorous self-administered surveys, our article may also help clinicians in the appraisal of published surveys.

CUTE LUNG INJURY AND ACUTE respiratory distress syndrome (ARDS, the most severe form of acute lung injury), are potentially devastating complications of critical illness. 1 Arising in response to direct lung injury (eg, pneumonia) or intense systemic inflammation (eg, sepsis), 2 the pathogenesis involves pulmonary edema, diffuse cellular destruction, alveolar collapse, and disordered repair. Mortality and health care costs are high, 3 and long-term survivors experience serious morbidity. 4 See also pp 646, 691, and 693.

ROTECTING LUNGS FROM VENTIlation-induced injury is an important principle in the management of patients with acute lung injury or acute respiratory distress syndrome (ARDS). Although the critical care community has generally endorsed lower tidal volumes and inspiratory pressures, the optimal level of positive end-expiratory pressure (PEEP) remains unestablished. 1,2 Experimental data suggest that PEEP levels exceeding traditional values of 5 to 12 cm H 2 O can minimize cyclical alveolar collapse and corresponding shearing injury to the lungs in patients with considerable edema and alveolar collapse. 3-5 For patients with relatively mild acute lung injury , however, potential adverse consequences of higher PEEP levels, including circulatory depression 6 or lung overdistension, 7 may outweigh the benefits. Several multicenter, randomized trials testing the incremental effect of higher levels See also p 883 and Patient Page.

Conference; ALI = acute lung injury; HMVEC(s) = human pulmonary microvascular endothelial cell(s); HNA(s) = human neutrophil antigen(s); LPS = lipopolysaccharide; lyso-PC(s) = lysophosphatidylcholine(s); SHOT = Serious Hazard of Transfusion.ransfusion-related acute lung injury (TRALI) is an uncommon clinical complication of allogeneic blood transfusion. Despite its increasing recognition over the past 5 years, much about TRALI remains poorly understood and controversial. Outstanding issues include the lack of a universally accepted case definition, uncertainty about incidence and pathogenesis, and disagreement about both how to manage