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Conclusion French pre-hospital invasive mechanical ventilation must be optimized with a full strategy of lung-protective ventilation with regards to tidal volume, pressure, oxygenation or capnia.
When no improvement is seen, invasive mechanical ventilation must be considered early to ensure the highest chance of survival for neutropenic patients with hypoxemic ARF.
When no rapid improvement is obtained, invasive mechanical ventilation must be considered early to ensure the highest chance of survival for hematology patients with hypoxemic ARF [ 13].
However, in patients who failed the NIV trial, prompt intubation and invasive mechanical ventilation must be provided due to related high mortality rates in this population [ 26].
See related letter by Rodriguez and Pravinkumar, http://ccforum.com/content/16/3/431 The process of weaning from mechanical ventilation must balance the risk of complications due to unnecessary delays in extubation with the risk of complications due to early discontinuation and the need for reintubation [ 1].
Determining the optimal time at which to discontinue mechanical ventilation must not be based simply on clinical impression because weaning depends on multiple factors [ 2, 3]: central drive and peripheral nerves; mechanical respiratory loads, ventilatory muscle properties and gas exchange properties; and cardiac tolerance and peripheral oxygen demands.
Similar(54)
Protective mechanical ventilation strategies must take into consideration the need to stabilize alveoli in order to prevent VILI.
Although the utility of indices related to respiratory changes in arterial pressure to detect preload sensitivity and thus volume responsiveness is indisputable in patients receiving mechanical ventilation, some limitations must be borne in mind.
First, we did not compare our results with a control group without anesthesia, or mechanical ventilation, because large animals must be anesthetized for procedures such as phrenic stimulation and Pdi recording.
We identified significant heterogeneity for administered surfactant and any mechanical ventilation and therefore these results must be interpreted with caution.
For example, even if the drop in SvO2 is secondary to an increase in VO2 (and not to a decrease in CO or DO2) during weaning from mechanical ventilation, this variation in SvO2 must be taken into consideration because it reflects the fact that the cardiorespiratory status of the patient does not fit the new situation.
Related(18)
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