editorial view - critical care canada forum · congratulations! («editorial view» is an easy...
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Giacomo Bellani, MD, PhDUniversity of Milan-Bicocca
A.O. San GerardoMonza (Italy)
Editorial view
@Gicobellani
Conflicts of Interest
INSTITUTIONAL: Research grants from:
– Draeger
– Maquet
– Airway Medix
– Chiesi Farmaceutica, SPA
Patent transferal to: Draeger
PERSONAL Consultancy fee from: Draeger
Lecturing fees: Draeger, GE, Pfizer
Co-owner and president of ReviewerCredits.com
SedationMuscle AtrophyHemodynamics
Better V/Q match
The dark side of spontaneousbreathing
Risk of high VtHigh inspiratory pressureAsynchroniesO2 Consumption
The bright side of spontaneous
breathing
Comment #2- inclusion criteriaModerate and severe ARDS
Civil war?
PaO2/FiO2
ACV
(n = 351)
BIPAP-APRV
(n = 346)
Baseline 133 (44) 137 (43)
Day 1 200 (77) 216 (120)
PaO2/FiO2
ACV
(n = 351)
BIPAP-APRV
(n = 346)
Baseline 133 (44) 137 (43)
0
10
20
30
40
50
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Spontaneous breathing(% Minute Ventilation)
mean + SD
Comment #3 - Was early Spont breathingreally achieved?
0
20
40
60
80
100
120
140
ACV BIPAP-APRV
mg
/day
Cisatracurium use
p = 0.014
0
50
100
150
200
250
300
350
400
ACV BIPAP-APRVm
g/d
ay
Cisatracurium use
Comment #4 - BIPAP and APRV
Pros: Decreased risk of non protective Vt Constant I:E (no breath stacking)
Cons: Modulation of patient effort rather tricky
Asynchronies +++
Conclusion
1. Congratulations! («editorial view» is an easy task…»)
2. Inclusion criteria
3. Was SB really achieved?
4. Subgroup analyses
1. Severe ARDS/mild ARDS
2. More/less «active» patients (dose response?)
5. Any benefit (or harm) for the diaphragm?