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In this article, the author discusses importance of noninvasive positive-pressure ventilation (NIPPV) in adult patients with severe respiratory distress, and mentions its benefits. It also mentions its benefits including decrease in number of hospital mortality. The author informs that seven randomized controlled trial (RCT) with 632 patients who were hypoxic respiratory failure and tachypnea for checking effectiveness of NIPPV.

The article presents information on a study regarding the effect of protective ventilation with lower tidal volumes on the ventilated patients without acute lung injury or the acute respiratory distress syndrome (ARDS). The method includes a randomized controlled trials and observational studies. Meta-analysis concludes that protective ventilation reduces lung injury, mortality, pulmonary infection, and atelectasis compared with conventional ventilation.

Question: In patients with early, severe acute respiratory distress syndrome (ARDS), does short-term treatment with cisatracurium besylate, a neuromuscular-blocking agent, improve clinical outcomes? Methods Design Randomized placebo-controlled trial (ARDS et Curarisation Systematique [ACURASYS] study). ClinicalTrials.gov NCT00299650. Allocation Concealed.* Blinding Blinded (patients, clinicians, outcome assessors, monitors, and data analysts).* Follow-up period 90 days. Setting 20 intensive care units (ICUs) in France. Patients 340 patients (mean age 58 y) who were receiving endotracheal mechanical ventilation for acute hypoxemic respiratory failure and had all of the following for >48 hours: PaO[sub 2]/FIO[sub 2] <>150 with ventilator set to a positive end-expiratory pressure >5 cm H[sub 2]0 and tidal volume of 6 to 8 mL/kg predicted body weight; bilateral pulmonary infiltrates consistent with edema; and no clinical evidence of left atrial hypertension. Exclusion criteria included pregnancy, increased intracranial pressure, severe chronic respiratory disease (chronic oxygen use or home ventilation), and severe chronic liver disease. Intervention Intravenous cisatracurium besylate (n =>178) or placebo (n =>162). After the Ramsay sedation score reached 6 (no response to glabellar tap) and ventilator settings were adjusted, a rapid infusion of 15 mg was administered, followed by a continuous infusion of 37.5 mg/h for 48 hours. Outcomes Primary outcome was 90-day mortality (before discharge and within 90 d after enrollment). Secondary outcomes included ventilator-free days, days without organ failure (cardiovascular, renal, hepatic, or coagulation abnormalities), barotrauma, and ICU-acquired paresis. Patient follow-up 99.7% (intention-to-treat analysis). Main results Patients who received cisatracurium had a lower adjusted risk for mortality at 90 days and lower risk for barotrauma (mostly pneumothorax) than those who received placebo (Table). The groups had a similar risk for ICU-acquired paresis at 28 days and ICU discharge; however, <>60% of patients were included in these analyses (29% [28/96] vs 32% [25/77], P =>0.64, and 36% [40/112] vs 31% [28/89], P =>0.51, respectively). At 28 days, the cisatracurium group had more ventilator-free days (mean 10.6 vs 8.5, P =>0.04) and days without organ failure (mean 15.8 vs 12.2, P =>0.01). Conclusion In patients with early, severe acute respiratory distress syndrome, short-term cisatracurium treatment reduced mortality at 90 days. [ABSTRACT FROM AUTHOR]

The article reports on a study focusing on the effectiveness of early tracheotomy in reducing ventilator-associated pneumonia (VAP) in adult patients ventilated for acute respiratory failure. The results showed significantly more ventilator-free days in the early tracheotomy group but not much difference in mortality or longer-term outcomes. Thus it demonstrated that early tracheotomy was not useful in reducing ventilator-associated pneumonia in adult patients.

The article focuses on a medical research related to the mechanically ventilated adult patients. It explores how does on demand ordering of chest radiographs compare with routine daily ordering for total number of chest radiographs performed per day. It concludes that on-demand ordering of chest radiographs reduced the number of chest radiographs performed per day compared with routine daily ordering in mechanically ventilated patients.