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Ewan C Goligher

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https://www.readbyqxmd.com/read/28930478/mechanical-ventilation-induced-diaphragm-atrophy-strongly-impacts-clinical-outcomes
#1
Ewan C Goligher, Martin Dres, Eddy Fan, Gordon D Rubenfeld, Damon C Scales, Margaret S Herridge, Stefannie Vorona, Michael C Sklar, Nuttapol Rittayamai, Ashley Lanys, Alistair Murray, Deborah Brace, Cristian Urrea, W Darlene Reid, George Tomlinson, Arthur S Slutsky, Brian P Kavanagh, Laurent J Brochard, Niall D Ferguson
Rationale Diaphragm dysfunction worsens outcomes in mechanically ventilated patients but the clinical impact of potentially preventable changes in diaphragm structure and function due to mechanical ventilation is unknown. Objectives To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation. Methods Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28917004/critical-illness-associated-diaphragm-weakness
#2
REVIEW
Martin Dres, Ewan C Goligher, Leo M A Heunks, Laurent J Brochard
Diaphragm weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilation but it also frequently develops during the ICU stay. Several risk factors for diaphragm weakness have been identified; among them sepsis and mechanical ventilation play central roles. We employ the term critical illness-associated diaphragm weakness to refer to the collective effects of all mechanisms of diaphragm injury and weakness occurring in critically ill patients...
September 15, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28698702/six-questions-about-physician-assisted-death-from-a-conscientious-objector
#3
Ewan C Goligher
No abstract text is available yet for this article.
May 2017: Linacre Quarterly
https://www.readbyqxmd.com/read/28684287/high-frequency-oscillatory-ventilation-in-adults-with-ards-past-present-and-future
#4
REVIEW
Michael C Sklar, Eddy Fan, Ewan C Goligher
High-frequency oscillatory ventilation (HFOV) is a unique mode of mechanical ventilation that uses nonconventional gas exchange mechanisms to deliver ventilation at very low tidal volumes and high frequencies. The properties of HFOV make it a potentially ideal mode to prevent ventilator-induced lung injury in patients with ARDS. Despite a compelling physiological basis and promising experimental data, large randomized controlled trials have not detected an improvement in survival with the use of HFOV, and its use as an early lung-protective strategy in patients with ARDS may be harmful...
July 3, 2017: Chest
https://www.readbyqxmd.com/read/28636403/applying-precision-medicine-to-trial-design-using-physiology-extracorporeal-co2-removal-for-acute-respiratory-distress-syndrome
#5
REVIEW
Ewan C Goligher, Marcelo B P Amato, Arthur S Slutsky
In clinical trials of therapies for acute respiratory distress syndrome (ARDS), the average treatment effect in the study population may be attenuated because individual patient responses vary widely. This inflates sample size requirements and increases the cost and difficulty of conducting successful clinical trials. One solution is to enrich the study population with patients most likely to benefit, based on predicted patient response to treatment (predictive enrichment). In this perspective, we apply the precision medicine paradigm to the emerging use of extracorporeal CO2 removal (ECCO2R) for ultraprotective ventilation in ARDS...
September 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28509756/the-authors-reply
#6
Ewan C Goligher, E Wesley Ely
No abstract text is available yet for this article.
June 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28459344/not-just-oxygen-mechanisms-of-benefit-from-high-flow-nasal-cannula-in-hypoxemic-respiratory-failure
#7
Ewan C Goligher, Arthur S Slutsky
No abstract text is available yet for this article.
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#8
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28146639/fifty-years-of-research-in-ards-setting-positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome
#9
REVIEW
Sarina K Sahetya, Ewan C Goligher, Roy G Brower
Positive end-expiratory pressure (PEEP) has been used during mechanical ventilation since the first description of acute respiratory distress syndrome (ARDS). In the subsequent decades, many different strategies for optimally titrating PEEP have been proposed. Higher PEEP can improve arterial oxygenation, reduce tidal lung stress and strain, and promote more homogenous ventilation by preventing alveolar collapse at end expiration. However, PEEP may also cause circulatory depression and contribute to ventilator-induced lung injury through alveolar overdistention...
June 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28098622/physician-assisted-suicide-and-euthanasia-in-the-icu-a-dialogue-on-core-ethical-issues
#10
Ewan C Goligher, E Wesley Ely, Daniel P Sulmasy, Jan Bakker, John Raphael, Angelo E Volandes, Bhavesh M Patel, Kate Payne, Annmarie Hosie, Larry Churchill, Douglas B White, James Downar
OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27855477/recruitment-manoeuvres-for-adults-with-acute-respiratory-distress-syndrome-receiving-mechanical-ventilation
#11
REVIEW
Carol Hodgson, Ewan C Goligher, Meredith E Young, Jennifer L Keating, Anne E Holland, Lorena Romero, Scott J Bradley, David Tuxen
BACKGROUND: Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009...
November 17, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27768396/effort-to-breathe-with-various-spontaneous-breathing-trial-techniques-a-physiologic-meta-analysis
#12
Michael C Sklar, Karen Burns, Nuttapol Rittayamai, Ashley Lanys, Michela Rauseo, Lu Chen, Martin Dres, Guang-Qiang Chen, Ewan C Goligher, Neill K J Adhikari, Laurent Brochard, Jan O Friedrich
RATIONALE: Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. OBJECTIVES: We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. METHODS: We searched Medline, Excerpta Medica Database, and Web of Science from inception to January 2016 to identify randomized and nonrandomized clinical trials reporting physiologic measurements of respiratory effort (pressure-time product) or work of breathing during at least two SBT techniques...
June 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27515160/will-all-ards-patients-be-receiving-mechanical-ventilation-in-2035-yes
#13
EDITORIAL
Ignacio Martin-Loeches, Lieuwe D Bos, Ewan C Goligher
No abstract text is available yet for this article.
April 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#14
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27248592/different-definitions-of-lung-recruitment-by-computed-tomography-scan
#15
Lu Chen, Michael Sklar, Martin Dres, Ewan C Goligher
No abstract text is available yet for this article.
June 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27203509/clinical-challenges-in-mechanical-ventilation
#16
REVIEW
Ewan C Goligher, Niall D Ferguson, Laurent J Brochard
Mechanical ventilation supports gas exchange and alleviates the work of breathing when the respiratory muscles are overwhelmed by an acute pulmonary or systemic insult. Although mechanical ventilation is not generally considered a treatment for acute respiratory failure per se, ventilator management warrants close attention because inappropriate ventilation can result in injury to the lungs or respiratory muscles and worsen morbidity and mortality. Key clinical challenges include averting intubation in patients with respiratory failure with non-invasive techniques for respiratory support; delivering lung-protective ventilation to prevent ventilator-induced lung injury; maintaining adequate gas exchange in severely hypoxaemic patients; avoiding the development of ventilator-induced diaphragm dysfunction; and diagnosing and treating the many pathophysiological mechanisms that impair liberation from mechanical ventilation...
April 30, 2016: Lancet
https://www.readbyqxmd.com/read/27040103/personalized-medicine-for-ards-the-2035-research-agenda
#17
Jeremy R Beitler, Ewan C Goligher, Matthieu Schmidt, Peter M Spieth, Alberto Zanella, Ignacio Martin-Loeches, Carolyn S Calfee, Alexandre B Cavalcanti
In the last 20 years, survival among patients with acute respiratory distress syndrome (ARDS) has increased substantially with advances in lung-protective ventilation and resuscitation. Building on this success, personalizing mechanical ventilation to patient-specific physiology for enhanced lung protection will be a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. Further understanding of the heterogeneous biology, from molecular to mechanical, underlying early ARDS pathogenesis is essential to inform therapeutic discovery and tailor treatment and prevention strategies to the individual patient...
May 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/26167730/evolution-of-diaphragm-thickness-during-mechanical-ventilation-impact-of-inspiratory-effort
#18
Ewan C Goligher, Eddy Fan, Margaret S Herridge, Alistair Murray, Stefannie Vorona, Debbie Brace, Nuttapol Rittayamai, Ashley Lanys, George Tomlinson, Jeffrey M Singh, Steffen-Sebastian Bolz, Gordon D Rubenfeld, Brian P Kavanagh, Laurent J Brochard, Niall D Ferguson
RATIONALE: Diaphragm atrophy and dysfunction have been reported in humans during mechanical ventilation, but the prevalence, causes, and functional impact of changes in diaphragm thickness during routine mechanical ventilation for critically ill patients are unknown. OBJECTIVES: To describe the evolution of diaphragm thickness over time during mechanical ventilation, its impact on diaphragm function, and the influence of inspiratory effort on this phenomenon. METHODS: In three academic intensive care units, 107 patients were enrolled shortly after initiating ventilation along with 10 nonventilated intensive care unit patients (control subjects)...
November 1, 2015: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/26075422/update-in-mechanical-ventilation-sedation-and-outcomes-2014
#19
REVIEW
Ewan C Goligher, Ghislaine Douflé, Eddy Fan
Novel approaches to the management of acute respiratory distress syndrome include strategies to enhance alveolar liquid clearance, promote epithelial cell growth and recovery after acute lung injury, and individualize ventilator care on the basis of physiological responses. The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards such as those set out by the ECMONet working group. Prognostic tools such as the RESP score can assist clinicians in predicting outcomes for patients with severe acute respiratory failure but do not predict whether ECMO will enhance survival...
June 15, 2015: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/25749574/measuring-diaphragm-thickness-with-ultrasound-in-mechanically-ventilated-patients-feasibility-reproducibility-and-validity
#20
Ewan C Goligher, Franco Laghi, Michael E Detsky, Paulina Farias, Alistair Murray, Deborah Brace, Laurent J Brochard, Steffen-Sebastien Bolz, Gordon D Rubenfeld, Brian P Kavanagh, Niall D Ferguson
No abstract text is available yet for this article.
April 2015: Intensive Care Medicine
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