High flow humidified nasal oxygen for respiratory failure has been gaining popularity both in adult and paediatric care in recent years. A number of studies have shown promising results. Announced last year but published this month, FLORALI was a multicenter, sealed randomization, pragmatic RCT with a well-defined study protocol, performed in more than 20 ICUs in France and …
The PHARLAP open lung approach showed promising short term benefit earlier on in the year in ARDS, but now the evidence for recruitment manoeuvres alone has been meta-analysed by Suzumura. Nearly 1600 patients. No standardized strategy, illness severity or timing. They at least seem safe but outcome gain is less clear. An attempt at isolating the studies with …
3 (fairly) recent studies (IMPROVE, PROVHILO, Defresne) show mixed benefit of using protective lung ventilation strategy with or without recruitment manoeuvres. Unimpressive results even in the obese. We know lungs de-recruit quickly under anaesthesia and that simple PEEP alone doesn’t help on radiological studies.
LITFL Wessex ICS BottomLine Emcrit