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The Cochrane Database of Systematic... May 2012Decompression illness (DCI) is due to bubble formation in the blood or tissues following the breathing of compressed gas. Clinically, DCI may range from a trivial... (Review)
Review
BACKGROUND
Decompression illness (DCI) is due to bubble formation in the blood or tissues following the breathing of compressed gas. Clinically, DCI may range from a trivial illness to loss of consciousness, death or paralysis. Recompression is the universally accepted standard treatment of DCI. When recompression is delayed, a number of strategies have been suggested in order to improve the outcome.
OBJECTIVES
To examine the effectiveness and safety of both recompression and adjunctive therapies in the treatment of DCI.
SEARCH METHODS
In our previous update we searched until October 2009. In this version we searched CENTRAL (The Cochrane Library, October 2011); MEDLINE (1966 to October 2011); CINAHL (1982 to October 2011); EMBASE (1980 to October 2011); the Database of Randomised Controlled Trials in Hyperbaric Medicine (October 2011); and handsearched journals and texts.
SELECTION CRITERIA
We included randomized controlled trials that compared the effect of any recompression schedule or adjunctive therapy with a standard recompression schedule. We did not apply language restrictions.
DATA COLLECTION AND ANALYSIS
Three authors extracted the data independently. We assessed each trial for internal validity and resolved differences by discussion. Data were entered into RevMan 5.1.
MAIN RESULTS
Two randomized controlled trials enrolling a total of 268 patients satisfied the inclusion criteria. The risk of bias for Drewry 1994 was unclear as this study was presented as an abstract, while Bennett 2003 was rated as at low risk. Pooling of data was not possible. In one study there was no evidence of improved effectiveness with the addition of a non-steroidal anti-inflammatory drug (tenoxicam) to routine recompression therapy (at six weeks: relative risk (RR) 1.04, 95% confidence interval (CI) 0.90 to 1.20, P = 0.58) but there was a reduction in the number of compressions required when tenoxicam was added from three to two (P = 0.01, 95% CI 0 to 1). In the other study, the odds of multiple recompressions were lower with a helium and oxygen (heliox) table compared to an oxygen treatment table (RR 0.56, 95% CI 0.31 to 1.00, P = 0.05).
AUTHORS' CONCLUSIONS
Recompression therapy is standard for the treatment of DCI, but there is no randomized controlled trial evidence for its use. Both the addition of a non-steroidal anti-inflammatory drug (NSAID) and the use of heliox may reduce the number of recompressions required, but neither improve the odds of recovery. The application of either of these strategies may be justified. The modest number of patients studied demands a cautious interpretation. Benefits may be largely economic and an economic analysis should be undertaken. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of different breathing gases and pressure profiles during recompression therapy.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Decompression Sickness; Humans; Hyperbaric Oxygenation; Piroxicam; Randomized Controlled Trials as Topic; Retreatment
PubMed: 22592704
DOI: 10.1002/14651858.CD005277.pub3 -
Journal of Special Operations Medicine... 2020There is growing concern that military breaching and training and firing artillery and mortars, grenades, and shoulder-fired weapons may have some type of cumulative...
There is growing concern that military breaching and training and firing artillery and mortars, grenades, and shoulder-fired weapons may have some type of cumulative deleterious effects. There are anecdotal reports of those with repetitive exposure to low-level blast complaining of various symptoms, as well as increasing empirical evidence. The purpose of this report is to provide a systematic review of the literature on repetitive lowlevel blast as it pertains to military and police training protocols. An extensive literature search was conducted, resulting in detailed review of 18 studies. Results suggest few consistent findings, likely due to the heterogeneity of methods, high risk of bias, and lack of reliance on objective blast-exposure data. Adverse effects, when present, dissipated over time. All studies that used blast gauges found significant associations, though only a subset actually reported using the blast-gauge data (to correlate objective exposure with outcomes). When comparing studies within an outcome domain (e.g., cognitive), findings were largely inconsistent. Research with larger sample sizes, followed longitudinally, is needed.
Topics: Blast Injuries; Explosions; Humans; Military Personnel; Police
PubMed: 32203612
DOI: 10.55460/3AC6-AX9I -
The Cochrane Database of Systematic... Oct 2017Effective synchronisation of infant respiratory effort with mechanical ventilation may allow adequate gas exchange to occur at lower peak airway pressures, potentially... (Review)
Review
BACKGROUND
Effective synchronisation of infant respiratory effort with mechanical ventilation may allow adequate gas exchange to occur at lower peak airway pressures, potentially reducing barotrauma and volutrauma and development of air leaks and bronchopulmonary dysplasia. During neurally adjusted ventilatory assist ventilation (NAVA), respiratory support is initiated upon detection of an electrical signal from the diaphragm muscle, and pressure is provided in proportion to and synchronous with electrical activity of the diaphragm (EADi). Compared to other modes of triggered ventilation, this may provide advantages in improving synchrony.
OBJECTIVES
Primary• To determine whether NAVA, when used as a primary or rescue mode of ventilation, results in reduced rates of bronchopulmonary dysplasia (BPD) or death among term and preterm newborn infants compared to other forms of triggered ventilation• To assess the safety of NAVA by determining whether it leads to greater risk of intraventricular haemorrhage (IVH), periventricular leukomalacia, or air leaks when compared to other forms of triggered ventilation Secondary• To determine whether benefits of NAVA differ by gestational age (term or preterm)• To determine whether outcomes of cross-over trials performed during the first two weeks of life include peak pressure requirements, episodes of hypocarbia or hypercarbia, oxygenation index, and the work of breathing SEARCH METHODS: We performed searches of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cohrane Library; MEDLINE via Ovid SP (January 1966 to March 2017); Embase via Ovid SP (January 1980 to March 2017); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host (1982 to March 2017); and the Web of Science (1985 to 2017). We searched abstracts from annual meetings of the Pediatric Academic Societies (PAS) (2000 to 2016); meetings of the European Society of Pediatric Research (published in Pediatric Research); and meetings of the Perinatal Society of Australia and New Zealand (PSANZ) (2005 to 2016). We also searched clinical trials databases to March 2017.
SELECTION CRITERIA
We included randomised and quasi-randomised clinical trials including cross-over trials comparing NAVA with other modes of triggered ventilation (assist control ventilation (ACV),synchronous intermittent mandatory ventilation plus pressure support (SIMV ± PS), pressure support ventilation (PSV), or proportional assist ventilation (PAV)) used in neonates.
DATA COLLECTION AND ANALYSIS
Primary outcomes of interest from randomised controlled trials were all-cause mortality, bronchopulmonary dysplasia (BPD; defined as oxygen requirement at 28 days), and a combined outcome of all-cause mortality or BPD. Secondary outcomes were duration of mechanical ventilation, incidence of air leak, incidence of IVH or periventricular leukomalacia, and survival with an oxygen requirement at 36 weeks' postmenstrual age.Outcomes of interest from cross-over trials were maximum fraction of inspired oxygen, mean peak inspiratory pressure, episodes of hypocarbia, and episodes of hypercarbia measured across the time period of each arm of the cross-over. We planned to assess work of breathing; oxygenation index, and thoraco-abdominal asynchrony at the end of the time period of each arm of the cross-over study.
MAIN RESULTS
We included one randomised controlled study comparing NAVA versus patient-triggered time-cycled pressure-limited ventilation. This study found no significant difference in duration of mechanical ventilation, nor in rates of BPD, pneumothorax, or IVH.
AUTHORS' CONCLUSIONS
Risks and benefits of NAVA compared to other forms of ventilation for neonates are uncertain. Well-designed trials are required to evaluate this new form of triggered ventilation.
Topics: Bronchopulmonary Dysplasia; Cerebral Intraventricular Hemorrhage; Humans; Infant, Newborn; Interactive Ventilatory Support; Leukomalacia, Periventricular; Respiratory Mechanics
PubMed: 29077984
DOI: 10.1002/14651858.CD012251.pub2 -
Journal of Critical Care Feb 2022To evaluate the effects of high and low levels of PEEP on ICU patients without ARDS. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the effects of high and low levels of PEEP on ICU patients without ARDS.
METHODS
We searched public databases (including PubMed, EMBASE, Cochrane Library and Clinicaltrial.gov). The Cochrane Risk of Bias Assessment tool was used to evaluate the quality of the included studies.
RESULTS
We included 2307 patients from 24 trials. Although no significant difference was found between high and low PEEP applications in in-hospital mortality (risk ratio[RR] 0.98, 95% confidence interval[CI] [0.81, 1.19], P = 0.87), high PEEP indeed decreased the incidence of ARDS, hypoxemia, and increased the level of PaO/FIO. In addition, although the overall results did not reveal any advantages of high PEEP in terms of secondary outcomes regarding 28-day mortality, the duration of ventilation, atelectasis, pulmonary barotrauma, hypotension, and so forth, the subgroup analysis concerning the level of low PEEP (ZEEP or not) and patient type (postoperative or medical ones) yielded different results. The TSA results suggested that more RCTs are needed.
CONCLUSIONS
Although ventilation with high PEEP in ICU patients without ARDS may not reduce in-hospital mortality, the decreased incidences of ARDS and hypoxemia and the improvement in PaO/FIO were found in the high PEEP arm.
Topics: Hospital Mortality; Humans; Intensive Care Units; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 34689064
DOI: 10.1016/j.jcrc.2021.09.026 -
Tuberkuloz Ve Toraks Jun 2022The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular...
The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular Dystrophy was successfully ventilated. Since then, the use of NIV has been on the rise throughout the world. Although a very modern and safe therapy, complications during its application are inevitable. In addition to some well-known complications, others have described more rare entities. In this article, we described such rare complications as pneumoperitoneum, pneumocephalus, parotitis, gastric perforation, and barotrauma. The purpose of this review was to describe unusual complications of NIV, their prevalence, and the mechanisms by which such complications arise. We performed a clinical review by searching PubMed, Embase, and Cochrane libraries with Mesh terms: 'non-invasive mechanical ventilation', 'high-flow nasal cannula', 'rare complication', 'unusual complication', and 'unexpected complication'. These terms were cross-referenced with other keywords: 'pneumoperitoneum', 'parotitis', 'pneumocephalus', 'gastric insufflation', and 'barotrauma'. We included 26 research papers. When applying mechanical ventilation, it is necessary to have a strong knowledge of the mechanics of the device as well as familiarity with the complications that may occur during its use, including less common ones. Prompt and effective treatment of such complications is required, as well as careful consideration of the potential causes of such events, during the application of NIV or HFNC.
Topics: Cannula; Humans; Noninvasive Ventilation; Oxygen Inhalation Therapy; Respiration, Artificial; Treatment Outcome
PubMed: 35785884
DOI: 10.5578/tt.20229810 -
The Cochrane Database of Systematic... Jul 2015Acute coronary syndrome (ACS), includes acute myocardial infarction and unstable angina, is common and may prove fatal. Hyperbaric oxygen therapy (HBOT) will improve... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute coronary syndrome (ACS), includes acute myocardial infarction and unstable angina, is common and may prove fatal. Hyperbaric oxygen therapy (HBOT) will improve oxygen supply to the threatened heart and may reduce the volume of heart muscle that perishes. The addition of HBOT to standard treatment may reduce death rate and other major adverse outcomes.This an update of a review previously published in May 2004 and June 2010.
OBJECTIVES
The aim of this review was to assess the evidence for the effects of adjunctive HBOT in the treatment of ACS. We compared treatment regimens including adjunctive HBOT against similar regimens excluding HBOT. Where regimens differed significantly between studies this is clearly stated and the implications discussed. All comparisons were made using an intention to treat analysis where this was possible. Efficacy was estimated from randomised trial comparisons but no attempt was made to evaluate the likely effectiveness that might be achieved in routine clinical practice. Specifically, we addressed:Does the adjunctive administration of HBOT to people with acute coronary syndrome (unstable angina or infarction) result in a reduction in the risk of death?Does the adjunctive administration of HBOT to people with acute coronary syndrome result in a reduction in the risk of major adverse cardiac events (MACE), that is: cardiac death, myocardial infarction, and target vessel revascularization by operative or percutaneous intervention?Is the administration of HBOT safe in both the short and long term?
SEARCH METHODS
We updated the search of the following sources in September 2014, but found no additional relevant citations since the previous search in June 2010 (CENTRAL), MEDLINE, EMBASE, CINAHL and DORCTHIM. Relevant journals were handsearched and researchers in the field contacted. We applied no language restrictions.
SELECTION CRITERIA
Randomised studies comparing the effect on ACS of regimens that include HBOT with those that exclude HBOT.
DATA COLLECTION AND ANALYSIS
Three authors independently evaluated the quality of trials using the guidelines of the Cochrane Handbook and extracted data from included trials. Binary outcomes were analysed using risk ratios (RR) and continuous outcomes using the mean difference (MD) and both are presented with 95% confidence intervals. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
No new trials were located in our most recent search in September 2014. Six trials with 665 participants contributed to this review. These trials were small and subject to potential bias. Only two reported randomisation procedures in detail and in only one trial was allocation concealed. While only modest numbers of participants were lost to follow-up, in general there is little information on the longer-term outcome for participants. Patients with acute coronary syndrome allocated to HBOT were associated with a reduction in the risk of death by around 42% (RR: 0.58, (95% CI 0.36 to 0.92), 5 trials, 614 participants; low quality evidence).In general, HBOT was well-tolerated. No patients were reported as suffering neurological oxygen toxicity and only a single patient was reported to have significant barotrauma to the tympanic membrane. One trial suggested a significant incidence of claustrophobia in single occupancy chambers of 15% (RR of claustrophobia with HBOT 31.6, 95% CI 1.92 to 521).
AUTHORS' CONCLUSIONS
For people with ACS, there is some evidence from small trials to suggest that HBOT is associated with a reduction in the risk of death, the volume of damaged muscle, the risk of MACE and time to relief from ischaemic pain. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. The routine application of HBOT to these patients cannot be justified from this review.
Topics: Acute Coronary Syndrome; Angina, Unstable; Humans; Hyperbaric Oxygenation; Myocardial Infarction; Randomized Controlled Trials as Topic
PubMed: 26202854
DOI: 10.1002/14651858.CD004818.pub4 -
The Cochrane Database of Systematic... Dec 2017Acute respiratory failure is a common life-threatening complication of acute onset neuromuscular diseases, and may exacerbate chronic hypoventilation in patients with... (Review)
Review
BACKGROUND
Acute respiratory failure is a common life-threatening complication of acute onset neuromuscular diseases, and may exacerbate chronic hypoventilation in patients with neuromuscular disease or chest wall disorders. Standard management includes oxygen supplementation, physiotherapy, cough assistance, and, whenever needed, antibiotics and intermittent positive pressure ventilation. Non-invasive mechanical ventilation (NIV) via nasal, buccal or full-face devices has become routine practice in many centres.
OBJECTIVES
The primary objective of this review was to compare the efficacy of non-invasive ventilation with invasive ventilation in improving short-term survival in acute respiratory failure in people with neuromuscular disease and chest wall disorders. The secondary objectives were to compare the effects of NIV with those of invasive mechanical ventilation on improvement in arterial blood gas after 24 hours and lung function measurements after one month, incidence of barotrauma and ventilator-associated pneumonia, duration of mechanical ventilation, length of stay in the intensive care unit and length of hospital stay.
SEARCH METHODS
We searched the following databases on 11 September 2017: the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE and Embase. We also searched conference proceedings and clinical trials registries.
SELECTION CRITERIA
We planned to include randomised or quasi-randomised trials with or without blinding. We planned to include trials performed in children or adults with acute onset neuromuscular diseases or chronic neuromuscular disease or chest wall disorders presenting with acute respiratory failure that compared the benefits and risks of invasive ventilation versus NIV.
DATA COLLECTION AND ANALYSIS
Two review authors reviewed searches and independently selected studies for assessment. We planned to follow standard Cochrane methodology for data collection and analysis.
MAIN RESULTS
We did not identify any trials eligible for inclusion in the review.
AUTHORS' CONCLUSIONS
Acute respiratory failure is a life-threatening complication of acute onset neuromuscular disease and of chronic neuromuscular disease and chest wall disorders. We found no randomised trials on which to elaborate evidence-based practice for the use of non-invasive versus invasive mechanical ventilation. For researchers, there is a need to design and conduct new randomised trials to compare NIV with invasive ventilation in acute neuromuscular respiratory failure. These trials should anticipate variations in treatment responses according to disease condition (acute onset versus acute exacerbation on chronic neuromuscular diseases) and according to the presence or absence of bulbar dysfunction.
Topics: Acute Disease; Humans; Neuromuscular Diseases; Noninvasive Ventilation; Respiration, Artificial; Respiratory Insufficiency; Thoracic Wall
PubMed: 29199768
DOI: 10.1002/14651858.CD008380.pub2 -
The Cochrane Database of Systematic... Apr 2007Decompression illness (DCI) is due to bubble formation in the blood or tissues following the breathing of compressed gas. Clinically, DCI may range from a trivial... (Review)
Review
BACKGROUND
Decompression illness (DCI) is due to bubble formation in the blood or tissues following the breathing of compressed gas. Clinically, DCI may range from a trivial illness to loss of consciousness, death or paralysis. Recompression is the universally accepted standard for the treatment of DCI. When recompression is delayed, a number of strategies have been suggested in order to improve the outcome.
OBJECTIVES
To examine the effectiveness and safety of both recompression and adjunctive therapies in the treatment of DCI.
SEARCH STRATEGY
We searched CENTRAL (The Cochrane Library 2005, Issue 2); MEDLINE (1966 to August 2005); CINAHL (1982 to August 2005); EMBASE (1980 to August 2005); the Database of Randomised Controlled Trials in Hyperbaric Medicine (August 2005), and hand-searched journals and texts.
SELECTION CRITERIA
We included randomized controlled trials that compared the effect of any recompression schedule or adjunctive therapy with a standard recompression schedule. We applied no language restrictions.
DATA COLLECTION AND ANALYSIS
Three authors extracted the data independently. We assessed each trial for internal validity and resolved differences by discussion. Data was entered into RevMan 4.2.
MAIN RESULTS
Two randomized controlled trials satisfied the inclusion criteria. Pooling of data was not possible. In one study there was no evidence of improved effectiveness with the addition of a non-steroidal anti-inflammatory drug (tenoxicam) to routine recompression therapy (at six weeks: relative risk (RR) 1.04, 95% confidence interval (CI) 0.90 to 1.20, P = 0.58) but there was a reduction in the number of compressions required when tenoxicam was added (P = 0.01, 95% CI 0 to 1). In the other study, the odds of multiple recompressions was lower with a helium and oxygen (heliox) table compared to an oxygen treatment table (RR 0.56, 95% CI 0.31 to 1.00, P = 0.05).
AUTHORS' CONCLUSIONS
Recompression therapy is standard for the treatment of DCI, but there is no randomized controlled trial evidence. Both the addition of an NSAID or the use of heliox may reduce the number of recompressions required, but neither improves the odds of recovery. The application of either of these strategies may be justified. The modest number of patients studied demands a cautious interpretation. Benefits may be largely economic and an economic analysis should be undertaken. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of different breathing gases and pressure profiles during recompression therapy.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Decompression Sickness; Humans; Hyperbaric Oxygenation; Piroxicam; Randomized Controlled Trials as Topic
PubMed: 17443579
DOI: 10.1002/14651858.CD005277.pub2 -
American Journal of Respiratory and... Dec 2008There are conflicting data regarding the safety and efficacy of recruitment maneuvers (RMs) in patients with acute lung injury (ALI). (Meta-Analysis)
Meta-Analysis Review
RATIONALE
There are conflicting data regarding the safety and efficacy of recruitment maneuvers (RMs) in patients with acute lung injury (ALI).
OBJECTIVES
To summarize the physiologic effects and adverse events in adult patients with ALI receiving RMs.
METHODS
Systematic review of case series, observational studies, and randomized clinical trials with pooling of study-level data.
MEASUREMENTS AND MAIN RESULTS
Forty studies (1,185 patients) met inclusion criteria. Oxygenation (31 studies; 636 patients) was significantly increased after an RM (PaO2): 106 versus 193 mm Hg, P = 0.001; and PaO2/FiO2 ratio: 139 versus 251 mm Hg, P < 0.001). There were no persistent, clinically significant changes in hemodynamic parameters after an RM. Ventilatory parameters (32 studies; 548 patients) were not significantly altered by an RM, except for higher PEEP post-RM (11 versus 16 cm H2O; P = 0.02). Hypotension (12%) and desaturation (9%) were the most common adverse events (31 studies; 985 patients). Serious adverse events (e.g., barotrauma [1%] and arrhythmias [1%]) were infrequent. Only 10 (1%) patients had their RMs terminated prematurely due to adverse events.
CONCLUSIONS
Adult patients with ALI receiving RMs experienced a significant increase in oxygenation, with few serious adverse events. Transient hypotension and desaturation during RMs is common but is self-limited without serious short-term sequelae. Given the uncertain benefit of transient oxygenation improvements in patients with ALI and the lack of information on their influence on clinical outcomes, the routine use of RMs cannot be recommended or discouraged at this time. RMs should be considered for use on an individualized basis in patients with ALI who have life-threatening hypoxemia.
Topics: Acute Lung Injury; Adult; Female; Hemodynamics; Humans; Male; Middle Aged; Oxygen; Respiration, Artificial; Respiratory Function Tests
PubMed: 18776154
DOI: 10.1164/rccm.200802-335OC -
Critical Care Medicine Feb 2014Inhaled anticoagulation regimens are increasingly being used to manage smoke inhalation-associated acute lung injury. We systematically reviewed published and... (Review)
Review
OBJECTIVE
Inhaled anticoagulation regimens are increasingly being used to manage smoke inhalation-associated acute lung injury. We systematically reviewed published and unpublished preclinical and clinical trial data to elucidate the effects of these regimens on lung injury severity, airway obstruction, ventilation, oxygenation, pulmonary infections, bleeding complications, and survival.
DATA SOURCES
PubMed, Scopus, EMBASE, and Web of Science were searched to identify relevant published studies. Relevant unpublished studies were identified by searching the Australian and New Zealand Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform, Cochrane Library, ClinicalTrials.gov, MINDCULL.com, Current Controlled Trials, and Google.
STUDY SELECTION
Inclusion criteria were any preclinical or clinical study in which 1) animals or subjects experienced smoke inhalation exposure, 2) they were treated with nebulized or aerosolized anticoagulation regimens, including heparin, heparinoids, antithrombins, or fibrinolytics (e.g., tissue plasminogen activator), 3) a control and/or sham group was described for preclinical studies, and 4) a concurrent or historical control group described for clinical studies. Exclusion criteria were 1) the absence of a group treated with a nebulized or aerosolized anticoagulation regimen, 2) the absence of a control or sham group, and 3) case reports.
DATA EXTRACTION
Ninety-nine potentially relevant references were identified. Twenty-seven references met inclusion criteria including 19 preclinical references reporting 18 studies and eight clinical references reporting five clinical studies.
DATA SYNTHESIS
A systematic review of the literature is provided. Both clinical and methodological diversity precluded combining these studies in a meta-analysis.
CONCLUSIONS
The high mortality associated with smoke inhalation-associated acute lung injury results from airway damage, mucosal dysfunction, neutrophil infiltration, airway coagulopathy with cast formation, ventilation-perfusion mismatching with shunt, and barotrauma. Inhaled anticoagulation regimens in both preclinical and clinical studies improve survival and decrease morbidity without altering systemic markers of clotting and anticoagulation. In some preclinical and clinical studies, inhaled anticoagulants were associated with a favorable effect on survival. This approach appears sufficiently promising to merit a well-designed prospective study to validate its use in patients with severe smoke inhalation-associated acute lung injury requiring mechanical ventilation.
Topics: Acute Lung Injury; Administration, Inhalation; Anticoagulants; Humans; Smoke Inhalation Injury
PubMed: 24158173
DOI: 10.1097/CCM.0b013e3182a645e5