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Ewan C Goligher

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https://www.readbyqxmd.com/read/27855477/recruitment-manoeuvres-for-adults-with-acute-respiratory-distress-syndrome-receiving-mechanical-ventilation
#1
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-physiological-meta-analysis
#2
Michael C Sklar, Karen Burns, Nuttapol Rittayamai, Ashley Lanys, Michela Rauseo, Lu Chen, Martin Dres, Guang-Qiang Chen, Ewan C Goligher, Neill Kj Adhikari, Laurent Brochard, Jan O Friedrich
Introduction Spontaneous breathing trials (SBTs) are designed to simulate conditions following extubation and it is essential to understand the physiological impact of different methods. 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, EMBASE, and Web of Science from inception to January 2016 to identify randomized and non-randomized clinical trials reporting physiological measurements of respiratory effort (pressure-time product, PTP) or work of breathing during at least 2 SBT techniques...
October 21, 2016: 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
#3
Ignacio Martin-Loeches, Lieuwe D Bos, Ewan C Goligher
No abstract text is available yet for this article.
August 11, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/25693448/measuring-diaphragm-thickness-with-ultrasound-in-mechanically-ventilated-patients-feasibility-reproducibility-and-validity
#11
Ewan C Goligher, Franco Laghi, Michael E Detsky, Paulina Farias, Alistair Murray, Deborah Brace, Laurent J Brochard, Steffen-Sebastien Bolz, Steffen Sebastien-Bolz, Gordon D Rubenfeld, Brian P Kavanagh, Niall D Ferguson
PURPOSE: Ultrasound measurements of diaphragm thickness (T di) and thickening (TFdi) may be useful to monitor diaphragm activity and detect diaphragm atrophy in mechanically ventilated patients. We aimed to establish the reproducibility of measurements in ventilated patients and determine whether passive inflation by the ventilator might cause thickening apart from inspiratory effort. METHODS: Five observers measured T di and TFdi in 96 mechanically ventilated patients...
April 2015: Intensive Care Medicine
https://www.readbyqxmd.com/read/25580530/physiologic-responsiveness-should-guide-entry-into-randomized-controlled-trials
#12
REVIEW
Ewan C Goligher, Brian P Kavanagh, Gordon D Rubenfeld, Niall D Ferguson
Most randomized trials in critical care report no mortality benefit; this may reflect competing pathogenic mechanisms, patient heterogeneity, or true ineffectiveness of interventions. We hypothesize that in acute respiratory distress syndrome (ARDS), randomizing only those patients who show a favorable physiological response to an intervention would help ensure that only those likely to benefit would be entered into the study. If true, this would decrease study "noise" and reduce required sample size, thereby increasing the chances of finding true-positive outcomes...
December 15, 2015: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/24919111/oxygenation-response-to-positive-end-expiratory-pressure-predicts-mortality-in-acute-respiratory-distress-syndrome-a-secondary-analysis-of-the-lovs-and-express-trials
#13
Ewan C Goligher, Brian P Kavanagh, Gordon D Rubenfeld, Neill K J Adhikari, Ruxandra Pinto, Eddy Fan, Laurent J Brochard, John T Granton, Alain Mercat, Jean-Christophe Marie Richard, Jean-Marie Chretien, Graham L Jones, Deborah J Cook, Thomas E Stewart, Arthur S Slutsky, Maureen O Meade, Niall D Ferguson
RATIONALE: Previous trials of higher positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) failed to demonstrate mortality benefit, possibly because of differences in lung recruitability among patients with ARDS. OBJECTIVES: To determine whether the physiological response to increased PEEP is associated with mortality. METHODS: In a secondary analysis of the Lung Open Ventilation Study (LOVS, n = 983), we examined the relationship between the initial response to changes in PEEP after randomization and mortality...
July 1, 2014: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/24434443/positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome-when-should-we-turn-up-the-pressure
#14
EDITORIAL
Ewan C Goligher, Jesús Villar, Arthur S Slutsky
No abstract text is available yet for this article.
February 2014: Critical Care Medicine
https://www.readbyqxmd.com/read/24267541/year-in-review-2012-critical-care-respirology
#15
REVIEW
Ewan C Goligher, Eddy Fan, Arthur S Slutsky
Acute respiratory failure is a dominant feature of critical illness. In this review, we discuss 17 studies published last year in Critical Care. The discussion focuses on articles on several topics: respiratory monitoring, acute respiratory distress syndrome, noninvasive ventilation, airway management, secretion management and weaning.
2013: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/23601696/re-evaluating-high-frequency-oscillation-for-ards-would-a-targeted-approach-be-successful
#16
COMMENT
Ewan C Goligher, Niall D Ferguson
High-frequency oscillatory ventilation (HFOV) seems ideal for lung protection in acute respiratory distress syndrome, but randomized trials have not shown a mortality reduction. The initial oxygenation response to HFOV appears to be associated with survival. Here, we discuss the mechanisms of oxygenation response to increases in airway pressure and the interpretation of the oxygenation response observed in the present study.
2013: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/22824937/core-competency-in-mechanical-ventilation-development-of-educational-objectives-using-the-delphi-technique
#17
Ewan C Goligher, Niall D Ferguson, Lisa P Kenny
OBJECTIVES: We sought to identify and standardize the core clinical knowledge and skills required to care for patients receiving mechanical ventilation. DESIGN: Prospective survey reaching consensus by the Delphi technique. SETTING: North American survey conducted anonymously by electronic e-mail. SUBJECTS: International experts in mechanical ventilation, frontline resident educators, medical education experts, and community intensivists were recruited to participate MEASUREMENTS AND MAIN RESULTS: Fourteen panelists participated (ten content experts, three resident educators, one medical education expert, zero community intensivists)...
October 2012: Critical Care Medicine
https://www.readbyqxmd.com/read/22743524/ventilator-induced-diaphragm-dysfunction-from-mice-hopefully-to-men
#18
EDITORIAL
Ewan C Goligher, Niall D Ferguson, Brian P Kavanagh
No abstract text is available yet for this article.
September 2012: Anesthesiology
https://www.readbyqxmd.com/read/22498733/utility-of-draining-pleural-effusions-in-mechanically-ventilated-patients
#19
REVIEW
Ewan C Goligher, Niall D Ferguson
PURPOSE OF REVIEW: Pleural effusions are prevalent in mechanically ventilated patients, and clinicians frequently consider draining the effusions. It is controversial whether patients benefit from pleural drainage in terms of either physiological or clinical outcomes. RECENT FINDINGS: Pleural drainage may be undertaken for a variety of reasons. Effusions are an important potential source of infection in patients with undifferentiated sepsis. Pleural drainage may improve hypoxemia or lung mechanics, but the physiological response depends on a complex interplay between lung and chest wall compliance, applied positive end-expiratory pressure and drainage volume...
July 2012: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/21288334/utility-and-safety-of-draining-pleural-effusions-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#20
REVIEW
Ewan C Goligher, Jerome A Leis, Robert A Fowler, Ruxandra Pinto, Neill K J Adhikari, Niall D Ferguson
INTRODUCTION: Pleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established. METHODS: We performed a literature search of multiple databases (MEDLINE, EMBASE, HEALTHSTAR, CINAHL) up to April 2010 to identify studies reporting clinical or physiological outcomes of mechanically ventilated critically ill patients who underwent drainage of pleural effusions. Studies were adjudicated for inclusion independently and in duplicate...
2011: Critical Care: the Official Journal of the Critical Care Forum
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