Critical care medicine
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Critical care medicine · Nov 2002
Randomized Controlled Trial Multicenter Study Clinical TrialInteractive effects of high-frequency oscillatory ventilation and inhaled nitric oxide in acute hypoxemic respiratory failure in pediatrics.
High-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) have been reported to improve oxygenation in children with acute hypoxemic respiratory failure (AHRF), but their roles in the treatment of AHRF remains unknown. The use of HFOV improves oxygenation by increasing lung recruitment. iNO can improve oxygenation in AHRF, but it may have limited efficacy in patients with poor lung inflation. Based on these findings, we hypothesized that the combined treatment of HFOV and inhalation of low-dose NO would improve oxygenation and survival in children with severe AHRF compared with children treated with conventional mechanical ventilation (CMV) or either treatment alone. ⋯ We conclude that the combination of HFOV with iNO causes a greater improvement in oxygenation than either treatment strategy alone in children with severe AHRF. We speculate that the enhanced lung recruitment by HFOV enhances the effects of low dose iNO on gas exchange.
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Critical care medicine · Nov 2002
Randomized Controlled Trial Clinical TrialCardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema.
Continuous positive airway pressure (CPAP) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. However, we hypothesized that bilevel noninvasive positive-pressure ventilation (NPPV), which combines both inspiratory pressure support and positive expiratory pressure, would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP. ⋯ This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema. In addition, NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload, which suggests an improvement in cardiac performance.