We have recently published a trial showing that the use of a no sedation strategy to critically ill patients requiring mechanical ventilation increased the number of ventilator free days and decreased both intensive care unit and total hospital length of stay [ 5].
We chose to focus on the diaphragm specifically because respiratory muscle weakness in the ICU is a major clinical problem [ 2, 3], and diaphragm weakness in ICU patients has been shown to result in poor outcomes, including prolonged duration of mechanical ventilation, increased incidence of patient transfers to long term ventilator units and higher ICU mortality [ 2, 3].
Only length of mechanical ventilation increased with half a day (aBeta = 0.55, p = 0.01).
In patients aged 70 years or older, complications during the course of mechanical ventilation increased the risk of hospital mortality [32].
Prolonged mechanical ventilation increased the risk of BPD in a clinical study, and this effect was stronger when chorioamnionitis was present [11].
A systematic review by Osawa and Singh [8] concluded that CMV disease in critically ill patients was associated with hepatic, respiratory, and renal dysfunctions; prolonged ICU stay, prolonged mechanical ventilation, increased incidence of bacterial and fungal infections, and increased mortality.
For instance Parker's group showed that neither low doses of oleic acid nor 25 cm H2O peak inspiratory pressure mechanical ventilation increased filtration coefficient and wet-to-dry ratio in an isolated-perfused rabbit lung model [37].
Compared with patients who tolerated extubation, those who require reintubation have prolonged duration of mechanical ventilation, increased length of ICU and hospital stay, and a higher incidence of mortality in some studies.
Loss of skeletal muscle is a typical and early finding in critically ill patients, mostly related to forced immobility, systemic inflammatory response, and protein depletion; it is clinically associated with a functional impairment that may cause difficult weaning from mechanical ventilation, increased length of ICU and hospital stay and long term functional disability.
Mechanical ventilation increased resistance and decreased compliance over time.
