Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation
Bibliographic record
Abstract
Also this year ICM published a number of interesting experimental articles, in large part focussed on mechanical ventilation, ARDS and sepsis. Mechanical ventilationVentilator-induced lung injury (VILI) is associated with inadequate inflammatory responses that lead to distal organ dysfunction.A variety of risk factors have been suggested to be involved in the pathogenesis of VILI in acute respiratory distress syndrome (ARDS), and it is noted that the mortality rate decreased in some younger but not other patients with ARDS.To test the hypothesis that aging increases the susceptibility to VILI and organ dysfunction, Dr. Esteban's group [1] conducted a study to mechanically ventilate young and old rats for an hour with a low or high tidal volume.They demonstrated that the high volume ventilatory strategy induced significantly greater systemic hypotension, cytokine production, distal organ dysfunction, and depressed vascular responses to catecholamines in the older than in the younger rats.The authors suggested that elderly subjects appear to be more prone to develop VILI and distal organ dysfunction compared to younger subjects.This interesting article was accompanied by an Editorial [2] to highlight the importance of the observation.Furthermore, the same group of investigators [3] demonstrated in the younger rats that the inflammatory responses and distal organ dysfunction induced by a short period (1 h) of high volume mechanical ventilation were reversible by 24-72 h in the surviving animals.This study suggests an important impact of the length of mechanical ventilation on the recovery of organ function, and multiple time points of a similar study are warranted.A number of studies have examined a variety of therapeutic approaches by improving ventilatory management or by using pharmacological intervention to reduce VILI in animal models.examined the effects of high-frequency percussive ventilation (HFPV), and compared it with high-frequency oscillatory ventilation (HFOV) and low volume ventilation on acute lung injury following gastric juice aspiration in rabbits.The HFPV was administered with a pneumatically powered volumetric diffusive respirator, which combines potential advantages of both high-frequency and convective ventilation.The investigators suggested that HFPV provided similar lung protective effects as did by HFOV and low volume ventilation, thus introduced an interesting therapeutic approach to attenuate VILI.It is noteworthy to mention that the neurally adjusted ventilatory assist (NAVA) has been shown to be protective in some experimental models of lung injury.NAVA utilizes
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.017 | 0.009 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".