Partial Ventilatory Support Modalities in Acute Lung Injury and Acute Respiratory Distress Syndrome—A Systematic Review

<div><h3>Purpose</h3><p>The efficacy of partial ventilatory support modes that allow spontaneous breathing in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is unclear. The objective of this scoping review was to assess the effects of partial ventilatory support on mortality, duration of mechanical ventilation, and both hospital and intensive care unit (ICU) lengths of stay (LOS) for patients with ALI and ARDS; the secondary objective was to describe physiologic effects on hemodynamics, respiratory system and other organ function.</p> <h3>Methods</h3><p>MEDLINE (1966–2009), Cochrane, and EmBase (1980–2009) databases were searched using common ventilator modes as keywords and reference lists from retrieved manuscripts hand searched for additional studies. Two researchers independently reviewed and graded the studies using a modified Oxford Centre for Evidence-Based Medicine grading system. Studies in adult ALI/ARDS patients were included for primary objectives and pre-clinical studies for supporting evidence.</p> <h3>Results</h3><p>Two randomized controlled trials (RCTs) were identified, in addition to six prospective cohort studies, one retrospective cohort study, one case control study, 41 clinical physiologic studies and 28 pre-clinical studies. No study was powered to assess mortality, one RCT showed shorter ICU length of stay, and the other demonstrated more ventilator free days. Beneficial effects of preserved spontaneous breathing were mainly physiological effects demonstrated as improvement of gas exchange, hemodynamics and non-pulmonary organ perfusion and function.</p> <h3>Conclusions</h3><p>The use of partial ventilatory support modalities is often feasible in patients with ALI/ARDS, and may be associated with short-term physiological benefits without appreciable impact on clinically important outcomes.</p> </div

Modified Oxford Centre for Evidence-Based Medicine Levels of Evidence (8).

<p>RCT = randomized control trial; SR = systematic review. For definitions refer to text.</p

Summary of results for clinical studies.

<p>APACHE2: Acute Physiology and Chronic Health Evaluation 2 Score; ARF: acute renal failure; CI: cardiac index; CPPV: continuous positive pressure ventilation; CRS: compliance (respiratory system); DO2: oxygen delivery; PaO2: partial pressure of oxygen (mmHg); PMAX/PINFLATION : upper and lower (respectively) pressure levels in APRV/BIPAP mode; LIS: lung-injury score; NR: not reported; RASS: Richmond Agitation Severity Score; SOFA: sequential organ failure assessment; VT: tidal volume; all other abbreviations as stated previously in the text.</p

Additional file 2: Figure S1. of Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis

Risk of bias for the included trials. (DOCX 30 kb

Additional file 1: of The influence of corticosteroid treatment on the outcome of influenza A(H1N1pdm09)-related critical illness

Appendix A (Table 5A. Unadjusted Clinical Outcomes among Critically Ill Patients with H1N1pdm09, Table 6A. Baseline Characteristics of Patients Matched by Propensity to Receive Corticosteroids among Critically Ill Patients with H1N1pdm09, Table 6B. Cointerventions Matched by Propensity to Receive Corticosteroids among Critically Ill Patients with H1N1pdm09, Table 6C. Outcome of Patients, Matched by Propensity to Receive Corticosteroids Among Critically Ill Patients with H1N1pdm09, Table 7A: Predictors of In-Hospital Mortality Using Adjustment for Baseline and Time-Dependent Between-Group Differences over the 4 Days of ICU Admission and Until Discharge From ICU Among Critically Ill Patients with H1N1pdm09) and Appendix B (Predictors of In-Hospital Mortality Among Critically Ill Patients with H1N1pdm09 Using Adjustment for Baseline and Time-Dependent Between-Group Differences) and Appendix C (Participating Hospitals) and Appendix D (Case Report Form). (ZIP 94 kb

Additional file 1: of Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial

Online supplement. (DOCX 63 kb

Additional file 2: of Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial

SPIRIT 2013 Checklist. (PDF 238 kb