Building on the Shoulders of Giants: Is the use of Early Spontaneous Ventilation in the Setting of Severe Diffuse Acute Respiratory Distress Syndrome Actually Heretical?

Abstract

the manuscript, references should be cited using Arabic numbers in parentheses. The reference styles for different types of publications are presented in the following examples.

Does volatile sedation with sevoflurane allow spontaneous breathing during prolonged prone positioning in intubated ARDS patients? A retrospective observational feasibility trial

“…The genesis of respiration and the respiratory drive are controlled by complex feedback loops and dependent on various parameters (paO 2 , paCO 2 , pH, inflammation, body temperature, agitation, etc.) described elsewhere [ 50 , 51 ]. Target values for paO2 [ 52 ] and blood pH [ 53 , 54 ] have been discussed especially.…”

How should dexmedetomidine and clonidine be prescribed in the critical care setting?

“…( 50 ) Indeed, mortality is reduced using controlled mechanical ventilation (CMV), paralysis and proning. ( 51 , 52 ) Nevertheless, a comparison of deep sedation + CMV + paralysis versus adequate spontaneous breathing ( 50 , 53 - 56 ) is missing. ( 50 ) Therefore, these advances ( 51 , 52 ) fall short methodologically, given a) the absence of a control group under adequate spontaneous breathing ( 50 ) and b) the tendency to shorten ( 57 , 58 ) GA + CMV + paralysis.…”

“…Spontaneous breathing is established as soon as ( 130 ) the factors evoking increased inspiratory activity are controlled (“respiratory drive”, tachypnea and hyperpnea): fever control, ( 131 - 133 ) agitation, ( 103 , 134 ) inflammation, ( 135 , 136 ) lung water, ( 123 ) systemic acidosis ( 136 - 138 ) and microcirculation, mild permissive hypercapnia (40 < PaCO 2 ≤ 50mmHg), ( 10 , 61 ) and upright positioning. ( 139 ) This was delineated ( 53 , 54 , 56 , 61 , 137 ) in table 1 in the reference. ( 55 ) The respiratory drive is not to be suppressed pharmacologically with GA, opioids or muscle relaxants but is used physiologically.…”

“…The physiological control of increased inspiratory activity leads to the absence of patient self-inflicted lung injury (P-SILI). ( 140 , 141 ) Then, the patient handles only one last factor of increased inspiratory activity, i.e., only hypoxemia under low PS-high PEEP ( 53 - 56 , 142 ) and cooperative sedation. Low driving pressure, ( 143 - 147 ) plateau pressure, minimal activity of inspiratory accessory muscles and no sternal notch retraction were observed.…”

Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition

“…We do not use conventional sedation in the CCU [ 8 ], except to speed up endotracheal intubation. Controlled mechanical ventilation with paralysis is used only for the shortest time interval to break self-inflicted lung injury (SILI) [ 30 ]. Then, the patient switches to adequate spontaneous breathing [ 31 , 32 , 33 ].…”