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We excluded studies employing a ventilatory strategy that maintained spontaneous breathing or generated a tidal volume <8 ml/kg.
The cardiac output during pressure-controlled ventilation with suppressed spontaneous breathing is higher than with maintained spontaneous breathing, and oxygen delivery is unaffected.
Thus, maintained spontaneous breathing may be favourable with respect to the perfusion and function of the kidney in patients requiring ventilatory support because of severe pulmonary dysfunction.
These findings show that, even in patients requiring ventilatory support, maintained spontaneous breathing can counteract progressive deterioration in pulmonary gas exchange.
Preliminary data in patients requiring ventilatory support for acute lung injury suggest that maintained spontaneous breathing may be beneficial for liver function.
A transient decrease in intrathoracic pressure resulting from maintained spontaneous breathing of 10 40% of total minute ventilation during APRV/BiPAP promotes venous return to the heart and right and left ventricular filling, thereby increasing cardiac output and DO2 [ 11].
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Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any ventilatory support.
Hence, maintaining spontaneous breathing has been advocated for patients with ARDS as it reduces shunt and decreases dead space [6 8].
Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury.
Therefore, in this case, we preferred to maintain spontaneous breathing, which is what we usually do when managing anticipated difficult airways in adults.
Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support.
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