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March 27, 1987, Vol 257, No. 12 >
ARTICLE | March 27, 1987

Liberation of the Patient From Mechanical Ventilation FREE

Jesse B. Hall, MD; Lawrence D. H. Wood, MD, PhD
[+] Author Affiliations

Reprint requests to Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60635 (Dr Hall).


JAMA. 1987;257(12):1621-1628. doi:10.1001/jama.1987.03390120083029
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Article
References

Discontinuation of mechanical ventilation is too frequently difficult and frustrating for the patient and the clinician alike. With the view that expeditious withdrawal of mechanical support is often a mirror-image exercise requiring reversal of the factors that led to respiratory failure, we begin with a discussion of the various pathophysiologies of respiratory failure. We then describe an approach emphasizing assessment of respiratory load and neuromuscular function at the bedside, with strategies outlined for diminishing mechanical load while conditioning and strengthening respiratory muscles to the point that spontaneous ventilation can be sustained.

(JAMA 1987;257:1621-1628)

REFERENCES

1 +
Zwillich CW, Pierson DJ, Creagh CE, et al:  Complications of assisted ventilation: A prospective study of 354 consecutive episodes . Am J Med 1974;; 57:161-170.
2 +
Pingleton SK:  Complications of acute respiratory failure . Med Clin North Am 1983;;67:725-746.
3 +
Wood LDH, Hall JB:  Management of the patient on a ventilator: Intensive and critical care medicine , in Proceedings of the Fourth World Congress on Intensive and Critical Care Medicine. 1985;, pp 72-75.
4 +
Sivak ED:  Prolonged mechanical ventilation: An approach to weaning . Cleve Clin Q 1980;;47:89-96.
5 +
Hall JB, Wood LDH:  Acute hypoxemic respiratory failure . Med Grand Rounds 1984;;3:183-195.
6 +
Milic-Emili J:  Recent advances in clinical assessment of control of breathing . Lung 1982;;160:1-17.
7 +
Pontoppidan H, Geffin B, Lowenstein E:  Acute respiratory failure in the adult . N Engl J Med 1972;;287:690-698.
8 +
Michel L, Serrano A, Malt RA:  Current concepts: Nutritional support of hospitalized patients . N Engl J Med 1981;;304:1147-1152.
9 +
Lemoyne M, Jeejeebhoy KN:  Total parenteral nutrition in the critically ill patient . Chest 1986;;89: 568-575.
10 +
Garibaldi RA, Britt MR, Coleman ML, et al:  Risk factors for postoperative pneumonia . Am J Med 1981;;70:677-680.
11 +
Haley RW, Hooton TM, Culver DH:  Nosocomial infections in U.S. hospitals, 1976-1978 . Am J Med 1981;;70:947-959.
12 +
Campbell EJ:  The management of acute respiratory failure in chronic bronchitis and emphysema . Am Rev Respir Dis 1967;;96:626-632.
13 +
Viires N, Sillye G, Aubier M, et al:  Regional blood flow distribution in the dog during induced hypotension and low cardiac output . J Clin Invest 1983;;72:935-947.
14 +
Hussain SNA, Roussos C:  Distribution of respiratory muscle and organ blood flow during endotoxic shock in dogs . J Appl Physiol 1985;;59: 1802-1808.
15 +
Hall JB, Wood LDH:  Pulmonary edema . Curr Ther Respir Dis 1986;;2:222-227.
16 +
Crandall ED:  Recent developments in pulmonary edema . Ann Intern Med 1983;;99:808-822.
17 +
Aberman A, Fulop M:  The metabolic and respiratory acidosis of acute pulmonary edema . Ann Intern Med 1972;;76:173-184.
18 +
Estenne M, Yernault JC:  The mechanism of CO2 retention in cardiac pulmonary edema . Chest 1984;;86:936-938.
19 +
Pare P, Warriner B, Baile EM, et al:  Redistribution of pulmonary extravascular water with PEEP in canine pulmonary edema . Am Rev Respir Dis 1983;;127:590-594.
20 +
Malo J, Ali J, Wood LDH:  How does positive end-expiratory pressure reduce intrapulmonary shunt in canine pulmonary edema? J Appl Physiol 1984;;57:1002-1010.
21 +
Cohen CA, Zagelbaum G, Gross D, et al:  Clinical manifestations of inspiratory muscle fatigue . Am J Med 1982;;73:308-316.
22 +
Roussos C, Macklem PT:  The respiratory muscles . N Engl J Med 1982;;307:786-797.
23 +
Grassino A, Macklem PT:  Respiratory muscle fatigue and ventilatory failure . Annu Rev Med 1984;;35:625-647.
24 +
Teplinsky K, Hall J:  Postictal pulmonary edema . Arch Intern Med 1986;;146:801-802.
25 +
Colice GL, Matthay MA, Bass E, et al:  Clinical commentary: Neurogenic pulmonary edema . Am Rev Respir Dis 1984;;130:941-948.
26 +
Barach AL, Martin J, Eckman M:  Positive pressure respiration and its application to the treatment of acute pulmonary edema . Ann Intern Med 1938;;12:754-760.
27 +
Civetta JM, Brons R, Gabel JC:  A simple and effective method of employing spontaneous positive pressure ventilation . J Thorax Cardiovasc Surg 1972;;63:312.
28 +
Light RB, Mink SN, Wood LDH:  Pathophysiology of gas exchange and pulmonary perfusion in pneumoccocal lobar pneumonia in dogs . J Appl Physiol 1981;;50:524-530.
29 +
Colligan T, Light RB, Wood LDH, et al:  Plasma volume expansion in canine pneumococcal pneumonia . Am Rev Respir Dis 1982;;126:86-91.
30 +
Kanarek DJ, Shannon DC:  Adverse effect of positive end-expiratory pressure on pulmonary perfusion and arterial oxygenation . Am Rev Respir Dis 1975;;12:457-459.
31 +
Mink SN, Light RB, Cooligan T, et al:  Effect of PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia . J Appl Physiol 1981;;50: 517-523.
32 +
Light RB, Mink SN, Wood LDH:  The effect of unilateral PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia . Anesthesiology 1981;;55:251-255.
33 +
Matthay RA, Moritz ED:  Invasive procedures for diagnosing pulmonary infection: A critical review . Clin Chest Med 1981;;2:3-18.
34 +
Chastre J, Viav F, Brun P, et al:  Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients . Am Rev Respir Dis 1984;;130:924-929.
35 +
Hall JB:  The cardiopulmonary failure of sleep-disordered breathing . JAMA 1986;;255:930-933.
36 +
Hall JB, Keamy MF III:  Artificial airways in the critically ill patient . Pulmonary and Critical Care Update 1986;;2:1-7.
37 +
Oppenheimer L, Craven KD, Forkert L, et al:  Pathophysiology of pulmonary contusion in dogs . J Appl Physiol 1979;;47:718-728.
38 +
Craven KD, Oppenheimer L, Wood LDH:  Effects of contusion and flail chest on pulmonary perfusion and oxygen exchange . J Appl Physiol 1979;;47:729-737.
39 +
Scully RE, Galdabini JJ, McNeely BU:  Case 48-1980, Case records of the Massachusetts General Hospital . N Engl J Med 1980;;303:1347-1355.
40 +
Hughes RAC, Kadlubowski M, Hufschmidt A:  Treatment of acute inflammatory polyneuropathy . Ann Neurol 1981;;9( (suppl) ):70-85.
41 +
Gracey DR, Divertie MB, Howard FM Jr:  Mechanical ventilation for respiratory failure in myasthenia gravis . Mayo Clin Proc 1983;;58:597.
42 +
Williams MH Jr:  Life-threatening asthma . Arch Intern Med 1980;;140:1604.
43 +
Scoggin CH, Sahn SA, Petty TL:  Status asthmaticus: A nine-year experience . JAMA 1977;;238: 1158.
44 +
Pepe PE, Marini JJ:  Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: The auto PEEP effect . Am Rev Respir Dis 1982;;126:166-170.
45 +
Fleury B, Murciano D, Talamo C, et al:  Work of breathing in patients with chronic obstructive pulmonary disease in acute respiratory failure . Am Rev Respir Dis 1985;;131:822-827.
46 +
Rossi A, Gottfried SB, Zocchi L, et al:  Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation: The effect of intrinsic positive end-expiratory pressure . Am Rev Respir Dis 1985;;131:672-677.
47 +
Ali J, Serrette C, Wood LDH, et al:  Effect of postoperative intermittent positive pressure breathing on lung function . Chest 1985;;85:192-196.
48 +
Simonneau G, Vivien A, Sartene R, et al:  Diaphragm dysfunction induced by upper abdominal surgery: The role of postoperative pain . Am Rev Respir Dis 1983;;128:899-903.
49 +
Sutter PM, Fairley HB, Isenberg MD:  Optimum end-expiratory airway pressure in patients with acute pulmonary failure . N Engl J Med 1975;; 292:284-289.
50 +
Wood LDH, Prewitt RM:  Cardiovascular management in acute hypoxemic respiratory failure . Am J Cardiol 1981;;47:963-972.
51 +
Pratter MR, Irwin RS:  Respiratory failure III: Bronchial asthma , in Rippe JM, Irwin RS, Alpert JS, et al (eds): Intensive Care Medicine . Boston, Little Brown & Co Inc, 1985;, pp 390-397.
52 +
Menitove SM, Goldring RM:  Combined ventilator and bicarbonate strategy in the management of status asthmaticus . Am J Med 1983;;74: 898-901.
53 +
Sahn SA, Laksnminarayan S:  Bedside criteria for discontinuation of mechanical ventilation . Chest 1973;;63:1002-1005.
54 +
Morganroth ML, Morganroth JL, Nett LM, et al:  Criteria for weaning from prolonged mechanical ventilation . Arch Intern Med 1984;;144:1012-1016.
55 +
Gottfried SB, Rossi A, Higgs BD, et al:  Noninvasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure . Am Rev Respir Dis 1985;;131: 414-420.
56 +
Marini JJ, Rodriguez M, Lamb V:  Bedside estimation of the inspiratory work of breathing during mechanical ventilation . Chest 1986;;89:56-63.
57 +
Rochester DF, Bettini G:  Diaphragmatic blood flow and energy expenditure in the dog . J Clin Invest 1976;;57:661-672.
58 +
Robertson CH, Foster GH, JohnsonRL Jr: The relationship of respiratory failure to the oxygen consumption of, lactate production by, and distribution of blood flow among respiratory muscles during increasing inspiratory resistance . J Clin Invest 1977;;59:31-42.
59 +
Scharf SM, Bark H, Einhorn S, et al:  Blood flow to the canine diaphragm during hemorrhagic shock . Am Rev Respir Dis 1986;;133:205-211.
60 +
Aubier M, Trippenbach T, Roussos C:  Respiratory muscle fatigue during cardiogenic shock . J Appl Physiol 1981;;51:499-508.
61 +
Hussain SNA, Graham R, Rutledge F, et al:  Respiratory muscle energetics during endotoxic shock in dogs . J Appl Physiol 1986;;60:486-493.
62 +
Gilbert R, Auchincloss JH, Peppi D, et al:  The first few hours off a respirator . Chest 1974;;65: 152-157.
63 +
Roussos CS, Macklem PT:  Diaphragmatic fatigue in man . J Appl Physiol 1977;;43:189-197.
64 +
Libby DM, Briscoe WA, King TKC:  Relief of hypoxia-related bronchoconstriction by breathing 30 per cent oxygen . Am Rev Respir Dis 1981;;123: 171-175.
65 +
Markland ON, Moorthy SS, Mohomed Y, et al:  Postoperative phrenic nerve palsy in patients with open-heart surgery . Ann Thorac Surg 1985;;39: 68-73.
66 +
Chandler KW, Rozas CJ, Kory RC, et al:  Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery . Am J Med 1984;;77:243-248.
67 +
Knochel JP:  Neuromuscular manifestations of electrolyte disorders . Am J Med 1982;;72:521-533.
68 +
Agus ZS, Wasserstein A, Goldfarb S:  Disorders of calcium and magnesium homeostasis . Am J Med 1982;;72:473-488.
69 +
Aubier M, Murciano D, Lecogguic Y, et al:  Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure . N Engl J Med 1985;;313:420-424.
70 +
Aubier M, De Troyer A, Sampson M, et al: Aminophylline improves diaphragmatic contractibility. N Engl J Med 1981;;305:249-252.
71 +
Viires N, Aubier M, Murciano D, et al:  Effects of aminophylline on diaphragmatic fatigue during acute respiratory failure . Am Rev Respir Dis 1984;; 129:396-402.
72 +
Bryant S, Edwards RHT, Faulkner JA, et al:  Respiratory muscle failure: Fatigue or weakness? The role of theophylline . Chest 1986;;89:116-124.
73 +
Askanazi J, Elwyn DH, Silverberg PA, et al:  Respiratory distress secondary to a high carbohydrate load: A case report . Surgery 1980;;87:596-598.
74 +
Covelli HD, Black JW, Olsen MS, et al:  Respiratory failure precipitated by high carbohydrate loads . Ann Intern Med 1981;;95:579-581.
75 +
Askanazi J, Nordenstrom J, Rosenbaum SH, et al:  Nutrition for the patient with respiratory failure: Glucose vs fat . Anesthesiology 1981;;54: 373-377.
76 +
Petty TL:  Principles of mechanical ventilation , in Petty TL (ed): Intensive and Rehabilitative Respiratory Care , ed 3. Philadelphia, Lea & Febiger, 1982;, pp 88-113.
77 +
Luce JM, Pierson DJ, Hudson LD:  Intermittent mandatory ventilation . Chest 1981;;79:678-685.
78 +
Groeger J, Levinson M, Ray C, et al:  Pressure support, SIMV and assist control (A/C) during acute respiratory failure (ARF) . Crit Care Med 1986;:376.
79 +
Boyer F, Gaussorgues P, Robert D:  Comparison of three modes of mechanical ventilation: Assist-controlled ventilation (ACV), intermittent mandatory ventilation (IMV), pressure support ventilation (PSV) . Am Rev Respir Dis 1986;; 133(pt (2) ):A345.
80 +
Hudson LD, Hurlow RS, Craig KC, et al:  Does intermittent mandatory ventilation correct respiratory alkalosis in patients receiving assisted mechanical ventilation? Am Rev Respir Dis 1985;;132: 1071-1074.
81 +
Culpepper JA, Rinaldo JE, Rogers RM:  Effect of mechanical ventilator mode on tendency towards respiratory alkalosis . Am Rev Respir Dis 1985;; 132:1075-1077.
82 +
Marini JJ, Rodriguez RM, Capps JS, et al:  The inspiratory work of breathing during assisted mechanical ventilation . Crit Care Med 1985;;13:310.
83 +
Capps JS, Marini JJ, Culver BH:  Work of breathing during mechanical ventilation . Crit Care-CP , section:A101.
84 +
Ward ME, Corbeil C, Gibbons W, et al:  Role of initiating inspiratory effort in determining work of breathing during mechanically assisted ventilation . Am Rev Respir Dis 1985;;131(pt (2) ):A131.
85 +
Ward ME, Corbeil C, Gibbons W, et al:  Work of breathing during mechanical ventilation as a function of peak inspiratory flow rate . Am Rev Respir Dis 1985;;131(pt (2) ):A131.
86 +
Marini JJ, Smith TC, Rodriguez RM, et al:  Inspiratory work of breathing during synchronized intermittent mandatory ventilation (SIMV) . Am Rev Respir Dis 1986;;133(pt (2) ):A120.
87 +
Gibbons WJ, Rotaple MJ, Newman SL:  Effect of intermittent mandatory ventilation on inspiratory muscle coordination in prolonged mechanically-ventilated patients . Am Rev Respir Dis 1986;;133(pt (2) ):A123.
88 +
Tobin MJ, Perez W, Guenther SM, et al:  The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation . Am Rev Respir Dis 1986;;134:1111-1118.

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Zwillich CW, Pierson DJ, Creagh CE, et al:  Complications of assisted ventilation: A prospective study of 354 consecutive episodes . Am J Med 1974;; 57:161-170.
2 +
Pingleton SK:  Complications of acute respiratory failure . Med Clin North Am 1983;;67:725-746.
3 +
Wood LDH, Hall JB:  Management of the patient on a ventilator: Intensive and critical care medicine , in Proceedings of the Fourth World Congress on Intensive and Critical Care Medicine. 1985;, pp 72-75.
4 +
Sivak ED:  Prolonged mechanical ventilation: An approach to weaning . Cleve Clin Q 1980;;47:89-96.
5 +
Hall JB, Wood LDH:  Acute hypoxemic respiratory failure . Med Grand Rounds 1984;;3:183-195.
6 +
Milic-Emili J:  Recent advances in clinical assessment of control of breathing . Lung 1982;;160:1-17.
7 +
Pontoppidan H, Geffin B, Lowenstein E:  Acute respiratory failure in the adult . N Engl J Med 1972;;287:690-698.
8 +
Michel L, Serrano A, Malt RA:  Current concepts: Nutritional support of hospitalized patients . N Engl J Med 1981;;304:1147-1152.
9 +
Lemoyne M, Jeejeebhoy KN:  Total parenteral nutrition in the critically ill patient . Chest 1986;;89: 568-575.
10 +
Garibaldi RA, Britt MR, Coleman ML, et al:  Risk factors for postoperative pneumonia . Am J Med 1981;;70:677-680.
11 +
Haley RW, Hooton TM, Culver DH:  Nosocomial infections in U.S. hospitals, 1976-1978 . Am J Med 1981;;70:947-959.
12 +
Campbell EJ:  The management of acute respiratory failure in chronic bronchitis and emphysema . Am Rev Respir Dis 1967;;96:626-632.
13 +
Viires N, Sillye G, Aubier M, et al:  Regional blood flow distribution in the dog during induced hypotension and low cardiac output . J Clin Invest 1983;;72:935-947.
14 +
Hussain SNA, Roussos C:  Distribution of respiratory muscle and organ blood flow during endotoxic shock in dogs . J Appl Physiol 1985;;59: 1802-1808.
15 +
Hall JB, Wood LDH:  Pulmonary edema . Curr Ther Respir Dis 1986;;2:222-227.
16 +
Crandall ED:  Recent developments in pulmonary edema . Ann Intern Med 1983;;99:808-822.
17 +
Aberman A, Fulop M:  The metabolic and respiratory acidosis of acute pulmonary edema . Ann Intern Med 1972;;76:173-184.
18 +
Estenne M, Yernault JC:  The mechanism of CO2 retention in cardiac pulmonary edema . Chest 1984;;86:936-938.
19 +
Pare P, Warriner B, Baile EM, et al:  Redistribution of pulmonary extravascular water with PEEP in canine pulmonary edema . Am Rev Respir Dis 1983;;127:590-594.
20 +
Malo J, Ali J, Wood LDH:  How does positive end-expiratory pressure reduce intrapulmonary shunt in canine pulmonary edema? J Appl Physiol 1984;;57:1002-1010.
21 +
Cohen CA, Zagelbaum G, Gross D, et al:  Clinical manifestations of inspiratory muscle fatigue . Am J Med 1982;;73:308-316.
22 +
Roussos C, Macklem PT:  The respiratory muscles . N Engl J Med 1982;;307:786-797.
23 +
Grassino A, Macklem PT:  Respiratory muscle fatigue and ventilatory failure . Annu Rev Med 1984;;35:625-647.
24 +
Teplinsky K, Hall J:  Postictal pulmonary edema . Arch Intern Med 1986;;146:801-802.
25 +
Colice GL, Matthay MA, Bass E, et al:  Clinical commentary: Neurogenic pulmonary edema . Am Rev Respir Dis 1984;;130:941-948.
26 +
Barach AL, Martin J, Eckman M:  Positive pressure respiration and its application to the treatment of acute pulmonary edema . Ann Intern Med 1938;;12:754-760.
27 +
Civetta JM, Brons R, Gabel JC:  A simple and effective method of employing spontaneous positive pressure ventilation . J Thorax Cardiovasc Surg 1972;;63:312.
28 +
Light RB, Mink SN, Wood LDH:  Pathophysiology of gas exchange and pulmonary perfusion in pneumoccocal lobar pneumonia in dogs . J Appl Physiol 1981;;50:524-530.
29 +
Colligan T, Light RB, Wood LDH, et al:  Plasma volume expansion in canine pneumococcal pneumonia . Am Rev Respir Dis 1982;;126:86-91.
30 +
Kanarek DJ, Shannon DC:  Adverse effect of positive end-expiratory pressure on pulmonary perfusion and arterial oxygenation . Am Rev Respir Dis 1975;;12:457-459.
31 +
Mink SN, Light RB, Cooligan T, et al:  Effect of PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia . J Appl Physiol 1981;;50: 517-523.
32 +
Light RB, Mink SN, Wood LDH:  The effect of unilateral PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia . Anesthesiology 1981;;55:251-255.
33 +
Matthay RA, Moritz ED:  Invasive procedures for diagnosing pulmonary infection: A critical review . Clin Chest Med 1981;;2:3-18.
34 +
Chastre J, Viav F, Brun P, et al:  Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients . Am Rev Respir Dis 1984;;130:924-929.
35 +
Hall JB:  The cardiopulmonary failure of sleep-disordered breathing . JAMA 1986;;255:930-933.
36 +
Hall JB, Keamy MF III:  Artificial airways in the critically ill patient . Pulmonary and Critical Care Update 1986;;2:1-7.
37 +
Oppenheimer L, Craven KD, Forkert L, et al:  Pathophysiology of pulmonary contusion in dogs . J Appl Physiol 1979;;47:718-728.
38 +
Craven KD, Oppenheimer L, Wood LDH:  Effects of contusion and flail chest on pulmonary perfusion and oxygen exchange . J Appl Physiol 1979;;47:729-737.
39 +
Scully RE, Galdabini JJ, McNeely BU:  Case 48-1980, Case records of the Massachusetts General Hospital . N Engl J Med 1980;;303:1347-1355.
40 +
Hughes RAC, Kadlubowski M, Hufschmidt A:  Treatment of acute inflammatory polyneuropathy . Ann Neurol 1981;;9( (suppl) ):70-85.
41 +
Gracey DR, Divertie MB, Howard FM Jr:  Mechanical ventilation for respiratory failure in myasthenia gravis . Mayo Clin Proc 1983;;58:597.
42 +
Williams MH Jr:  Life-threatening asthma . Arch Intern Med 1980;;140:1604.
43 +
Scoggin CH, Sahn SA, Petty TL:  Status asthmaticus: A nine-year experience . JAMA 1977;;238: 1158.
44 +
Pepe PE, Marini JJ:  Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: The auto PEEP effect . Am Rev Respir Dis 1982;;126:166-170.
45 +
Fleury B, Murciano D, Talamo C, et al:  Work of breathing in patients with chronic obstructive pulmonary disease in acute respiratory failure . Am Rev Respir Dis 1985;;131:822-827.
46 +
Rossi A, Gottfried SB, Zocchi L, et al:  Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation: The effect of intrinsic positive end-expiratory pressure . Am Rev Respir Dis 1985;;131:672-677.
47 +
Ali J, Serrette C, Wood LDH, et al:  Effect of postoperative intermittent positive pressure breathing on lung function . Chest 1985;;85:192-196.
48 +
Simonneau G, Vivien A, Sartene R, et al:  Diaphragm dysfunction induced by upper abdominal surgery: The role of postoperative pain . Am Rev Respir Dis 1983;;128:899-903.
49 +
Sutter PM, Fairley HB, Isenberg MD:  Optimum end-expiratory airway pressure in patients with acute pulmonary failure . N Engl J Med 1975;; 292:284-289.
50 +
Wood LDH, Prewitt RM:  Cardiovascular management in acute hypoxemic respiratory failure . Am J Cardiol 1981;;47:963-972.
51 +
Pratter MR, Irwin RS:  Respiratory failure III: Bronchial asthma , in Rippe JM, Irwin RS, Alpert JS, et al (eds): Intensive Care Medicine . Boston, Little Brown & Co Inc, 1985;, pp 390-397.
52 +
Menitove SM, Goldring RM:  Combined ventilator and bicarbonate strategy in the management of status asthmaticus . Am J Med 1983;;74: 898-901.
53 +
Sahn SA, Laksnminarayan S:  Bedside criteria for discontinuation of mechanical ventilation . Chest 1973;;63:1002-1005.
54 +
Morganroth ML, Morganroth JL, Nett LM, et al:  Criteria for weaning from prolonged mechanical ventilation . Arch Intern Med 1984;;144:1012-1016.
55 +
Gottfried SB, Rossi A, Higgs BD, et al:  Noninvasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure . Am Rev Respir Dis 1985;;131: 414-420.
56 +
Marini JJ, Rodriguez M, Lamb V:  Bedside estimation of the inspiratory work of breathing during mechanical ventilation . Chest 1986;;89:56-63.
57 +
Rochester DF, Bettini G:  Diaphragmatic blood flow and energy expenditure in the dog . J Clin Invest 1976;;57:661-672.
58 +
Robertson CH, Foster GH, JohnsonRL Jr: The relationship of respiratory failure to the oxygen consumption of, lactate production by, and distribution of blood flow among respiratory muscles during increasing inspiratory resistance . J Clin Invest 1977;;59:31-42.
59 +
Scharf SM, Bark H, Einhorn S, et al:  Blood flow to the canine diaphragm during hemorrhagic shock . Am Rev Respir Dis 1986;;133:205-211.
60 +
Aubier M, Trippenbach T, Roussos C:  Respiratory muscle fatigue during cardiogenic shock . J Appl Physiol 1981;;51:499-508.
61 +
Hussain SNA, Graham R, Rutledge F, et al:  Respiratory muscle energetics during endotoxic shock in dogs . J Appl Physiol 1986;;60:486-493.
62 +
Gilbert R, Auchincloss JH, Peppi D, et al:  The first few hours off a respirator . Chest 1974;;65: 152-157.
63 +
Roussos CS, Macklem PT:  Diaphragmatic fatigue in man . J Appl Physiol 1977;;43:189-197.
64 +
Libby DM, Briscoe WA, King TKC:  Relief of hypoxia-related bronchoconstriction by breathing 30 per cent oxygen . Am Rev Respir Dis 1981;;123: 171-175.
65 +
Markland ON, Moorthy SS, Mohomed Y, et al:  Postoperative phrenic nerve palsy in patients with open-heart surgery . Ann Thorac Surg 1985;;39: 68-73.
66 +
Chandler KW, Rozas CJ, Kory RC, et al:  Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery . Am J Med 1984;;77:243-248.
67 +
Knochel JP:  Neuromuscular manifestations of electrolyte disorders . Am J Med 1982;;72:521-533.
68 +
Agus ZS, Wasserstein A, Goldfarb S:  Disorders of calcium and magnesium homeostasis . Am J Med 1982;;72:473-488.
69 +
Aubier M, Murciano D, Lecogguic Y, et al:  Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure . N Engl J Med 1985;;313:420-424.
70 +
Aubier M, De Troyer A, Sampson M, et al: Aminophylline improves diaphragmatic contractibility. N Engl J Med 1981;;305:249-252.
71 +
Viires N, Aubier M, Murciano D, et al:  Effects of aminophylline on diaphragmatic fatigue during acute respiratory failure . Am Rev Respir Dis 1984;; 129:396-402.
72 +
Bryant S, Edwards RHT, Faulkner JA, et al:  Respiratory muscle failure: Fatigue or weakness? The role of theophylline . Chest 1986;;89:116-124.
73 +
Askanazi J, Elwyn DH, Silverberg PA, et al:  Respiratory distress secondary to a high carbohydrate load: A case report . Surgery 1980;;87:596-598.
74 +
Covelli HD, Black JW, Olsen MS, et al:  Respiratory failure precipitated by high carbohydrate loads . Ann Intern Med 1981;;95:579-581.
75 +
Askanazi J, Nordenstrom J, Rosenbaum SH, et al:  Nutrition for the patient with respiratory failure: Glucose vs fat . Anesthesiology 1981;;54: 373-377.
76 +
Petty TL:  Principles of mechanical ventilation , in Petty TL (ed): Intensive and Rehabilitative Respiratory Care , ed 3. Philadelphia, Lea & Febiger, 1982;, pp 88-113.
77 +
Luce JM, Pierson DJ, Hudson LD:  Intermittent mandatory ventilation . Chest 1981;;79:678-685.
78 +
Groeger J, Levinson M, Ray C, et al:  Pressure support, SIMV and assist control (A/C) during acute respiratory failure (ARF) . Crit Care Med 1986;:376.
79 +
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To understand the clinical management of acute heart failure syndromes.
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The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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