FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2114425550> ?p ?o ?g. }

• W2114425550 endingPage "1446" @default.
• W2114425550 startingPage "1445" @default.
• W2114425550 abstract "Dr Sessler has provided a number of arguments in an attempt to counter or at least soften a positive interpretation of the study supporting a role for neuromuscular blockade (NMB) as a therapeutic adjunct during mechanical ventilation of patients with severe ARDS.1Sessler CN Counterpoint: should paralytic agents be routinely used in severe ARDS? No.Chest. 2013; 144: 1442-1445Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 2Papazian L Forel JM Gacouin A ACURASYS Study Investigators et al.Neuromuscular blockers in early acute respiratory distress syndrome.N Engl J Med. 2010; 363: 1107-1116Crossref PubMed Scopus (1587) Google Scholar Although these arguments are thoughtful and well presented, even in aggregate they do not dissuade me from my initial position. He points out that there may be a disconnect between the patients reported in the trial and those whom practicing physicians actually care for, as suggested by the fact that only 25% of eligible patients were enrolled. For better or for worse, this is the reality of clinical trials and is not different from the usual circumstances of trying to apply evidence from trials to practice. I believe that we are better off with the results of trials conducted under a careful protocol than being limited to observational data from real-world circumstances. Dr Sessler also notes, as did I, that the post hoc analysis suggested that the treatment effect was limited to the subset of patients with a Pao2/Fio2 ratio < 120 mm Hg. I view this as very helpful information to guide the clinician in the use of NMB in the sickest patients (as measured by this physiologic signal). This information even suggests that clinicians might use the results of the study to restrict their use of NMB because, as Dr Sessler notes, as many as 25% to 55% of patients enrolled in modern ARDS trials received NMB.2Papazian L Forel JM Gacouin A ACURASYS Study Investigators et al.Neuromuscular blockers in early acute respiratory distress syndrome.N Engl J Med. 2010; 363: 1107-1116Crossref PubMed Scopus (1587) Google Scholar, 3Mercat A Richard JC Vielle B Expiratory Pressure (Express) Study Group et al.Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.JAMA. 2008; 299: 646-655Crossref PubMed Scopus (975) Google Scholar, 4Meade MO Cook DJ Guyatt GH Lung Open Ventilation Study Investigators et al.Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.JAMA. 2008; 299: 637-645Crossref PubMed Scopus (1032) Google Scholar, 5Brower RG Lanken PN MacIntyre N National Heart, Lung, and Blood Institute ARDS Clinical Trials Network et al.Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.N Engl J Med. 2004; 351: 327-336Crossref PubMed Scopus (1783) Google Scholar, 6Talmor D Sarge T Malhotra A et al.Mechanical ventilation guided by esophageal pressure in acute lung injury.N Engl J Med. 2008; 359: 2095-2104Crossref PubMed Scopus (756) Google Scholar The relatively low positive end-expiratory pressure (PEEP) levels used in the Papazian et al2Papazian L Forel JM Gacouin A ACURASYS Study Investigators et al.Neuromuscular blockers in early acute respiratory distress syndrome.N Engl J Med. 2010; 363: 1107-1116Crossref PubMed Scopus (1587) Google Scholar trial do not likely limit the interpretation of benefit because it is not likely that higher PEEP levels would achieve greater patient-ventilator synchrony, which I believe is a likely mechanism by which this benefit occurs. Higher PEEP levels would not likely result in the observation of lower levels of barotrauma in the treatment group. The particulars of NMB administration in the trial, that is, a fixed dose and lack of peripheral nerve stimulation titration, were necessary study design elements to avoid obvious unblinding of group allocation. Had standard approaches to NMB administration been used, a strong criticism of observer bias likely would have been raised. I share the concern for potentiation of ICU-acquired weakness by NMB, but I will simply note that this was not seen within the limitations of assessment of muscle strength conducted in the trial. On this point I am sure that Dr Sessler and I share a desire to have information available, even in the form of observational data, from larger patient populations followed for longer periods of time. Finally, Dr Sessler's observation that the benefits seen in this trial may not be seen with NMB agents other than cisatracurium for the reasons he cites is insightful. I agree that cisatracurium should be the preferred agent in this setting until studies with other NMB agents are available. Accordingly, I agree with Dr Sessler that translation of the results of trials to practice is challenging and must be done carefully. I agree that the results of the Papazian et al2Papazian L Forel JM Gacouin A ACURASYS Study Investigators et al.Neuromuscular blockers in early acute respiratory distress syndrome.N Engl J Med. 2010; 363: 1107-1116Crossref PubMed Scopus (1587) Google Scholar trial should be considered to address specifically the use of cisatracurium in patients with severe ARDS receiving mechanical ventilation. However, until additional studies evaluate this approach, I believe that NMB should be considered a beneficial adjunct to our strategies for lung-protective mechanical ventilation." @default.
• W2114425550 created "2016-06-24" @default.
• W2114425550 creator A5091774540 @default.
• W2114425550 date "2013-11-01" @default.
• W2114425550 modified "2023-09-24" @default.
• W2114425550 title "Rebuttal From Dr Hall" @default.
• W2114425550 cites W2074856208 @default.
• W2114425550 cites W2109704422 @default.
• W2114425550 cites W2115186092 @default.
• W2114425550 cites W2116685432 @default.
• W2114425550 cites W2120076396 @default.
• W2114425550 cites W2333411966 @default.
• W2114425550 doi "https://doi.org/10.1378/chest.13-1461" @default.
• W2114425550 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24189856" @default.
• W2114425550 hasPublicationYear "2013" @default.
• W2114425550 type Work @default.
• W2114425550 sameAs 2114425550 @default.
• W2114425550 citedByCount "0" @default.
• W2114425550 crossrefType "journal-article" @default.
• W2114425550 hasAuthorship W2114425550A5091774540 @default.
• W2114425550 hasConcept C126322002 @default.
• W2114425550 hasConcept C17744445 @default.
• W2114425550 hasConcept C177713679 @default.
• W2114425550 hasConcept C1862650 @default.
• W2114425550 hasConcept C199539241 @default.
• W2114425550 hasConcept C23131810 @default.
• W2114425550 hasConcept C2776348555 @default.
• W2114425550 hasConcept C2777310092 @default.
• W2114425550 hasConcept C2777714996 @default.
• W2114425550 hasConcept C2779473830 @default.
• W2114425550 hasConcept C2909621147 @default.
• W2114425550 hasConcept C535046627 @default.
• W2114425550 hasConcept C67761136 @default.
• W2114425550 hasConcept C71924100 @default.
• W2114425550 hasConcept C83867959 @default.
• W2114425550 hasConceptScore W2114425550C126322002 @default.
• W2114425550 hasConceptScore W2114425550C17744445 @default.
• W2114425550 hasConceptScore W2114425550C177713679 @default.
• W2114425550 hasConceptScore W2114425550C1862650 @default.
• W2114425550 hasConceptScore W2114425550C199539241 @default.
• W2114425550 hasConceptScore W2114425550C23131810 @default.
• W2114425550 hasConceptScore W2114425550C2776348555 @default.
• W2114425550 hasConceptScore W2114425550C2777310092 @default.
• W2114425550 hasConceptScore W2114425550C2777714996 @default.
• W2114425550 hasConceptScore W2114425550C2779473830 @default.
• W2114425550 hasConceptScore W2114425550C2909621147 @default.
• W2114425550 hasConceptScore W2114425550C535046627 @default.
• W2114425550 hasConceptScore W2114425550C67761136 @default.
• W2114425550 hasConceptScore W2114425550C71924100 @default.
• W2114425550 hasConceptScore W2114425550C83867959 @default.
• W2114425550 hasIssue "5" @default.
• W2114425550 hasLocation W21144255501 @default.
• W2114425550 hasLocation W21144255502 @default.
• W2114425550 hasOpenAccess W2114425550 @default.
• W2114425550 hasPrimaryLocation W21144255501 @default.
• W2114425550 hasRelatedWork W1965469124 @default.
• W2114425550 hasRelatedWork W2024847614 @default.
• W2114425550 hasRelatedWork W2035579010 @default.
• W2114425550 hasRelatedWork W2084364101 @default.
• W2114425550 hasRelatedWork W2461875524 @default.
• W2114425550 hasRelatedWork W2470098754 @default.
• W2114425550 hasRelatedWork W2969541092 @default.
• W2114425550 hasRelatedWork W3096001562 @default.
• W2114425550 hasRelatedWork W3164939693 @default.
• W2114425550 hasRelatedWork W4293744104 @default.
• W2114425550 hasVolume "144" @default.
• W2114425550 isParatext "false" @default.
• W2114425550 isRetracted "false" @default.
• W2114425550 magId "2114425550" @default.
• W2114425550 workType "article" @default.