International Variation in Intubation and Extubation Practices Among Critically Ill Patients Receiving Mechanical Ventilation

International Variation in Intubation and Extubation Practices Among Critically Ill Patients Receiving Mechanical Ventilation

Requiring invasive mechanical ventilation acutely outside an operating room is, for many, the definition of critical illness. Although there may be debate regarding whether patients treated with noninvasive ventilation or... read more

Natriuretic Peptide–driven Fluid Management during Ventilator Weaning

Natriuretic Peptide–driven Fluid Management during Ventilator Weaning

Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. In a randomized controlled... read more

High Breath-by-Breath Variability Is Associated With Extubation Failure in Children

High Breath-by-Breath Variability Is Associated With Extubation Failure in Children

High respiratory variability during spontaneous breathing trials is independently associated with extubation failure in children, with very high rates of extubation failure when these children develop postextubation upper... read more

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

Predicting the optimal time for extubation is challenging, especially in patients with underlying diaphragm dysfunction. Incorporating ultrasound information on diaphragm function into usual care allowed clinicians to identify... read more

Use of Supraglottic Airways During COVID-19 Pandemic

Use of Supraglottic Airways During COVID-19 Pandemic

This document is produced in response to questions about the use of supraglottic airways (SGAs) during the current pandemic. The advice that it contains is based on the expert opinion of airway specialists and is meant to... read more

Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists

Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists

No significant impact of transitions of care observed between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood... read more

Holding Intubated Infants Well Tolerated and Safe

Holding Intubated Infants Well Tolerated and Safe

Critically ill infants who are old enough to move on their own but too young to cooperate with care instructions have been among the last to benefit from patient mobility initiatives. Results from a holding intervention... read more

Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated With Early Extubation Following Infant Cardiac Surgery

Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated With Early Extubation Following Infant Cardiac Surgery

The implementation of an early extubation clinical practice guideline resulted in a reduction in the dose of opioids and benzodiazepines without a change in volatile anesthetic agent used in the operating room. Intraoperative... read more

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure

Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Among 364 randomized... read more

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Ventilation

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Ventilation

This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive... read more

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation, when the reasons for intubation... read more

Safety and Efficacy of VBF in Critically Ill, Mechanically Ventilated Adults Using the PERFECT Protocol

Safety and Efficacy of VBF in Critically Ill, Mechanically Ventilated Adults Using the PERFECT Protocol

Underfeeding in critical illness is common and associated with poor outcomes. According to large prospective hospital studies, volume-based feeding (VBF) safely and effectively improves energy and protein delivery to critically... read more

Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in ICU Patients Without ARDS

Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in ICU Patients Without ARDS

In patients in the Intensive Care Unit (ICU) without acute respiratory distress syndrome (ARDS) who were expected not to be extubated within 24 hours of randomization, a low tidal volume strategy did not result in a greater... read more

Risk Stratification Using Oxygenation in the First 24 Hours of Pediatric ARDS

Risk Stratification Using Oxygenation in the First 24 Hours of Pediatric ARDS

Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially... read more