Comparison of Optimal Positive End-Expiratory Pressure and Recruitment Maneuvers During Lung-Protective Mechanical Ventilation in Patients With Acute Lung Injury/Acute Respiratory Distress Syndrome

Optimal Positive End-Expiratory Pressure and Recruitment Maneuvers During Lung-Protective Mechanical Ventilation

Describe the experimental design (RCT, observational, cross-over, etc.):

There were different experimental designs in this article firstly, the Randomized controlled trial was used and it revealed that the tidal volume was the one that helped the patient for survival. Secondly, the crossover study/design was used as different patients who were suffering from acute lung injury (ALI)/acute respiratory distress syndrome were subjected to different treatments and exposures. This was done using a controlled experiment and was repeated severally to show how the patients were fairing after he/she was randomly assigned to a sequence of treatments. Thirdly, the observation design was so similar to the crossover one and they produced the same results which were that during the tidal breathe the mechanical ventilation could not fully offer lung protection especially from over distention. Through observation, RCT, observation and crossover helped to reach to the conclusion that 30% of patients with ARDS were having End-aspiratory over-distention

What/who are the subjects in this study?

The subjects of the study are the patients who were suffering from the with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

What inclusion and exclusion criteria were used?

The inclusion criteria helped the ones who were performing the experiment to establish a baseline with their subjects and they were able to screen the potential participants they also considered other general factors.  The ones who were included were the ones that after being mechanically ventilated for ARDS or ALI were having a stable hemodynamic, they had an arterial catheter in plan and they were approved by their next of kin and they were 18yrs old. The exclusion criteria were helped in elimination of the participants who had no specific set of requirements and so they could not safely participate in a clinical trial.

In both the exclusion and inclusion criteria they used the age, type and stage of disease. Most importantly, they thoroughly investigated the best lung-recruitment method by using various recruitment methods with their different effects on the lungs. Therefore, the inclusion criteria was helpful and included the ones who could pass the recruitment method while as exclusion criteria was to eliminate the ones who could not pass the recruitment method and maybe risky to use them as the subjects of the experiment.

How do we know if there was IRB approval and/or animal care protection?

We know because it is an original research and we are told that the protocol was approved.

Describe any clinically significant differences.

The clinically significant difference is in the respiratory mechanics, hemodynamic and the arterial blood gas values as well as the PEEP strategy factor effect. The newly found therapy was essential for it helped to alter the practice. By so doing the ones conducting the experiment were able to determine the difference between the two therapies, measure if it is huge enough to facilitate the alteration of the practice. This was essential in that it helped to determine which subject was suitable to use for the experiment.

Explain how you know if a power study was performed and if it was important.

 I know that the power of study was used because it can be calculated even without determining the sample size. Power study was used to test the hypothesis especially if the sighs were significantly improving the oxygenation. The power study was essential for it helped in the testing of the hypothesis.

Discussion and Conclusions Section

What are the similarities and differences from previous research that were discovered in this study?

The similarities can be found in the end results of the experiments whereby both of them confirmed the hypothesis and the analysis of variance was used in both for analyzing the overall effect of the PEEP strategy group.

The differences occurs on the samples that were used the control group and the methods that were used. In addition, the present study did not use a great number of patients and the alveolar recruitment was not assessed. There was the usage of the oxygenation and the recruitment which was not so much considered in the other studies.

What were the limitations of the study?

There were only 12 patients who were used for the study and the alveolar recruitment was not assessed. Oxygenation could not be considered as a significant clinical outcome especially for the patients who were having ALI/ARDS and the size of the study could not provide the information on the patients end results.

What do you think are the unanswered questions as a result of this study? What should be done next?

I think that the unanswered questions of this study are how effective was the outcome  especially when it comes to the usage of the recruitment and the oxygenation as the determinant of the patients important findings and what could be done to eliminate the limitations that are provided by the study. I think what could be done is to find effective methods for the research especially when it comes the determination of the patients outcome.

Explain how you know if the study has external validity.

 I know that it has an external validity because results of a study can be generalized to other situations and to other people.

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