Effects of aggressive and conservative strategies for mechanical ventilation liberation

Shahn, Zach; Choudhri, Aman; Jung, Boris; Talmor, Daniel; Lehman, Li-wei H.; Baedorf‐Kassis, Elias N.

doi:10.1016/j.jcrc.2023.154275

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Although clinicians generally agree that in order to qualify for weaning, there need to be improvements in oxygenation, the underlying disease process, and overall degree of critical illness, the degree of improvement remains under debate. Identifying patients who are ready for this transition to lower levels of PEEP, let alone spontaneous assisted breathing remains an area of active investigation [11 ▪ ]. Nevertheless, these early studies demonstrating the benefit of SAT/SBTs, unanimously required that in order for patients to qualify for a SBT, their PEEP had to already be equal to or less than 5 cmH 2 O.…”

Section: Introductionmentioning

confidence: 99%

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

McNamara,

Baedorf Kassis

2023

Current Opinion in Critical Care

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Purpose of review Positive-end expiratory pressure (PEEP) is a tool in managing acute respiratory distress syndrome (ARDS). In this review, we discuss the various approaches to weaning PEEP after the acute phase of ARDS. Recent findings There is a paucity of research specifically looking at the differences between PEEP weaning protocols. Data in some populations though, particularly those with elevated BMI, suggest that a physiologic approach to PEEP weaning may be helpful. Use of various tools to optimize PEEP prior to and during spontaneous breathing trials (SBTs) may allow for improved alveolar recruitment and respiratory outcomes. Summary Although further prospective studies are warranted, we should consider using a physiologic approach to PEEP weaning in ARDS rather than a one size fits all model, which is currently the standard used in many clinical trials and throughout many ICUs.

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Section: Introductionmentioning

confidence: 99%

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

McNamara,

Baedorf Kassis

2023

Current Opinion in Critical Care

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The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure

Shahn,

Jung,

Talmor

et al. 2024

Journal of Critical Care

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Causal inference using observational intensive care unit data: a scoping review and recommendations for future practice

Smit,

Krijthe,

Kant

et al. 2023

npj Digit. Med.

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This scoping review focuses on the essential role of models for causal inference in shaping actionable artificial intelligence (AI) designed to aid clinicians in decision-making. The objective was to identify and evaluate the reporting quality of studies introducing models for causal inference in intensive care units (ICUs), and to provide recommendations to improve the future landscape of research practices in this domain. To achieve this, we searched various databases including Embase, MEDLINE ALL, Web of Science Core Collection, Google Scholar, medRxiv, bioRxiv, arXiv, and the ACM Digital Library. Studies involving models for causal inference addressing time-varying treatments in the adult ICU were reviewed. Data extraction encompassed the study settings and methodologies applied. Furthermore, we assessed reporting quality of target trial components (i.e., eligibility criteria, treatment strategies, follow-up period, outcome, and analysis plan) and main causal assumptions (i.e., conditional exchangeability, positivity, and consistency). Among the 2184 titles screened, 79 studies met the inclusion criteria. The methodologies used were G methods (61%) and reinforcement learning methods (39%). Studies considered both static (51%) and dynamic treatment regimes (49%). Only 30 (38%) of the studies reported all five target trial components, and only seven (9%) studies mentioned all three causal assumptions. To achieve actionable AI in the ICU, we advocate careful consideration of the causal question of interest, describing this research question as a target trial emulation, usage of appropriate causal inference methods, and acknowledgement (and examination of potential violations of) the causal assumptions.

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Effects of aggressive and conservative strategies for mechanical ventilation liberation

Cited by 3 publications

References 26 publications

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure

Causal inference using observational intensive care unit data: a scoping review and recommendations for future practice

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