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 …
We rightly like to avoid intubation in COPD exacerbations. Extracorporeal CO2 removal or ‘pulmonary dialysis’ has been around for a while and many feel it is beneficial in COPD (eg this case) but who is it best used for? In an Italian matched cohort study Del Sorbo and colleagues looked at 200 patients with an exacerbation …
Proning in ICU is 40 years old now. Meta-analyse 11 high-quality studies in a thorough manner (including blinding to authors!) and it appears strikingly good, with an NNT of 11 – definitely better than protective ventilation alone. Do it in the severely hypoxic (P/F <100 mmHg), do it early (within 72 hours), do it for …
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.
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