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Although Adam et al. [ 2] recently reported an MICU mortality rate of only 22%, only 49% of their patients required mechanical ventilation (versus 75% in our study), and mortality was highest in the mechanically ventilated patients.
Where are the RCTs of mechanical ventilation versus normobaric oxygen in ARDS, or inotropes versus placebo in septic shock?
Ninety-nine percentage of LSP underwent mechanical ventilation versus 68%% of SSP (p < 0.0001), with a mean of 36.6 ± 28.0 days of mechanical ventilation.
Initially, patients in group I were more severe: 18 % had an acute respiratory distress versus 12%%; 62 % needed mechanical ventilation versus 64%%; 31 % had septic shock versus 26%% and acute kidney failure (50.7 vs 41%%).
‖ P = 0.0241, mechanical ventilation versus no ventilation.
Case patients had a longer duration of mechanical ventilation versus control: 21 (9–53) days versus 5 (2–18) days, respectively, P < 0.001.
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Data from cohorts comparing survivors with non-survivors showed differences in age (42.3 versus 51.2 years), prior time on conventional mechanical ventilation (4.0 versus 6.2 days), APACHE II score (22.4 versus 26.1), pH (7.33 versus 7.26) and oxygenation index (26 versus 34).
Supporting such a possibility, in the ENHANCE study, patients treated later were more likely to require vasopressor agents (76% versus 71%) and mechanical ventilation (88% versus 75%) than those treated within 24 hours of OD [ 5].
However, non-ICU patients had lower frequency of shock (25% versus 57%; P = 0.007) and mechanical ventilation (25% versus 60%; P = 0.007), a lower ATN-ISS (0.41 versus 0.78; P < 0.001), a lower AP1 (16.5 versus 19; P = 0.02) and a lower risk of death as calculated using the AP1 (23% versus 50%; P < 0.001).
Non-enrolled patients were more likely to require mechanical ventilation (12% versus 6.6%) and die (6.7% versus 3.2%).
They found significant differences in the duration of mechanical ventilation (30.8 versus 6.5 days), rates of pneumonia (40% versus 10%), and mortality (30% versus 0%) between the surgical patients with and without pulmonary contusion.
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