Top 100 ICU Papers – Respiratory Support


Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C
Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes.
American Journal of Respiratory and Critical Care Medicine 2002;166:1510-4
A meta-analysis that explains why low-Vt works in some studies (e.g. NEJM 2000,342,1301–1308 ARDSNet) and not others!

Fernandez R, Trenchs X, Klamburg J, Castedo J, Serrano JM et al.
Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial.
ICM 2008;34:1487-91
CCM 2008;36:603-9
CMAJ 2008;178:1153-61
Three meta-analyses in the three months preceding this, and you have a cold topic getting hot again!

Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R
Mechanical ventilation guided by esophageal pressure in acute lung injury.
NEJM 2008,359,2095-2104 Talmor
Oh, so narrowly missed a significant mortality benefit – why, oh why did they stop early? 

Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D et al, for ARDSNET
Comparison of two fluid-management strategies in acute lung injury.
NEJM 2006,354,2564-2575 ARDSNet
Read the editorial and extensivecorrespondence as well

Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD et al.
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.
Lancet 2008; 371: 126-34.
NNT = 7.4 for mortality! PubMed Abstract

Burns KE, Adhikari NK, Meade MO.
A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation.
Can J Anaesth 2006,53,305-315 Burns
Can’t get them off the ventilator? Just extubate to mask BiPAP
Cochrane 2010,CD004127 Burns

Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C et al.
Noninvasive positive-pressure ventilation for respiratory failure after extubation.
NEJM 2004,350,2452-2460 Esteban
……But it’s no good waiting for respiratory failure to set in – NIV too late only makes things worse!

Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD.
Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis.
Lancet 2006,367,1155-1163 Peter
Hmmm…. I think I’d rather have the CPAP than the BiPAP, thanks

Adhikari NK, Burns KE, Friedrich JO, Granton JT, Cook DJ, Meade MO.
Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis.
BMJ 2007,334,779 Adhikari
A disappointing performance from 1992’s Molecule Of The Year

Meduri GU, Marik PE, Chrousos GP, Pastores SM, Arlt W et al.
Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature.
ICM 2008,34,61-69 Meduri
Meduri tells them how it should be done…..

Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A
Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis.
British Medical Journal 2008; 336: 1006-9.
And after three rounds of Meduri vs ARDS-NET, it’s …. too close to call!
PubMed Abstract            BMJ Full Text

Salluh JI, Póvoa P, Soares M, Castro-Faria-Neto HC, Bozza FA, Bozza PT
The role of corticosteroids in severe community-acquired pneumonia: a systematic review.
Critical Care 2008; 12: R76
A fairly luke-warm conclusion for what seemed like very positive findings?
PubMed Abstract            Critical Care Full Text

Fan T, Wang G, Mao B, Xiong Z, Zhang Y, Liu X, Wang L, Yang S
Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials.
BMJ 2008,337,a1841 Fan
More steroids, anyone? A medical student provides the decider in Roberts et al vs the Cochrane Review……

Canadian Critical Care Trials Group; Heyland D, Dodek P, Muscedere J, Day A.
A randomized trial of diagnostic techniques for ventilator-associated pneumonia.
NEJM 2006,355,2619-2630 CCCTG
How you diagnose it makes no difference……………

Safdar N, Dezfulian C, Collard HR, Saint S
Clinical and economic consequences of ventilator-associated pneumonia: a systematic review.
CCM 2005,33,2184-2193 Safdar
…….. but actually having it certainly does!

Blot F, Similowski T, Trouillet JL, Chardon P, Korach JM et al.
Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients.
Intensive Care Medicine 2008; 34: 1779-87
Blot et al. stealing a march on TracMan
PubMed Abstract

Colebourn CL, Barber V, Young JD.
Use of helium-oxygen mixture in adult patients presenting with exacerbations of asthma and chronic obstructive pulmonary disease: a systematic review.
Anaesthesia 2007,62,34-42 Colebourn
Heliox: it’s good (but not VERY good)………….

Chalwin RP, Moran JL, Graham PL.
The role of extracorporeal membrane oxygenation for treatment of the adult respiratory distress syndrome: review and quantitative analysis.
Anaesthesia and Intensive Care 2008; 36: 152-61.
We’re still waiting in suspense for CESAR to get published – but here’s a sneak peek PubMed Abstract

Müller T, Lubnow M, Philipp A, Bein T, Jeron A et al.
Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy.
European Respiratory Journal 2009; 33: 551-8
And now: pocket ECMO! (no batteries required)
PubMed Abstract

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