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Ventilatory adjuncts
1Department of Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA. rkacmarek@partners.org
Respiratory Care
|March 5, 2002
Summary
Adjuncts to mechanical ventilation, including automatic tube compensation, high frequency oscillation (HFO), and prone positioning, are under investigation. While partial liquid ventilation (PLV) may be abandoned, HFO and prone positioning show potential pending further trials.
Area of Science:
- Critical care medicine
- Respiratory therapy
- Mechanical ventilation adjuncts
Background:
- Mechanical ventilation requires adjuncts to improve patient outcomes.
- Automatic tube compensation aims to reduce patient effort from endotracheal tubes.
- Recent research evaluated high frequency oscillation (HFO), partial liquid ventilation (PLV), and prone positioning.
Purpose of the Study:
- To review recent randomized controlled trials (RCTs) of mechanical ventilation adjuncts.
- To assess the current status and future prospects of HFO, PLV, and prone positioning.
- To identify the need for further research on tracheal gas insufflation.
Main Methods:
- Review of negative randomized controlled trials for HFO, PLV, and prone positioning.
- Analysis of trends and potential limitations in trial protocols.
- Identification of adjuncts with ongoing research or lacking clinical trials.
Main Results:
- RCTs for HFO, PLV, and prone positioning were negative.
- PLV is likely to be abandoned; HFO showed a trend toward benefit.
- Prone positioning trial protocols require scrutiny; tracheal gas insufflation lacks trials and commercial products.
Conclusions:
- Adjuncts like HFO and prone positioning require further RCTs to determine efficacy.
- PLV is unlikely to be adopted in clinical practice soon.
- Tracheal gas insufflation needs investigation, but commercial availability is a concern.