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BACKGROUND Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. METHODS Anesthetized pigs were intubated via the trachea and mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway. Each pig was randomly assigned to 1 of 2 groups closed suctioning alone (control group, 7 pigs), or manual rib cage compression combined with closed suctioning (manual rib cage compression group, 8 pigs). Hard and brief rib cage compression synchronized with early expiratory phase was tested. Mucus clearance and oxygenation were assessed after the intervention. Sequential changes of hemodynamics were assessed after the intervention. RESULTS During hard manual rib cage compression, the mean ± SD peak expiratory flow increased to 44 ± 7 L/min compared with 31 ± 7 L/min without treatment (P less then .001). Manual rib cage compression combined with endotracheal suctioning increased mucus clearance compared with closed suctioning alone (mucus amounts, 5.5 [3.4-9.4] g vs 0.7 [0.5-2.0] g; P = .004); however, it did not improve gas exchange and radiologic findings. There were no significant differences in hemodynamic variables between the 2 groups. CONCLUSIONS Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation. Copyright © 2020 by Daedalus Enterprises.Oxygen has long been considered a vital and potentially life-saving component of emergency care. Given this, there is widespread and liberal use of supplemental oxygen in hospitals across the United States and throughout the world. Recent research, however, delineates serious deleterious effects at the cellular level, inducing damage to the cardiovascular system, the central nervous system, the pulmonary system, and beyond. A scoping review was conducted to identify and synthesize available research data as it pertains to the clinical effects of hyperoxia in critically ill adult patients in acute care settings. We searched PubMed, MEDLINE, CINAHL, and Scopus databases. We also reviewed the reference lists of included publications. The selection of relevant articles was conducted by 2 researchers at 2 levels of screening. The review identified 30 studies, of which 5 were randomized controlled trials, 2 were prospective cohort studies, and 23 were retrospective cohort studies. A descriptive analysis of study results was performed. Current evidence suggests an association between hyperoxia and increased mortality after cardiac arrest, stroke, and traumatic brain injury, as well as in the setting of sepsis, although there is insufficient evidence to conclude concretely that hyperoxia effects clinical outcomes. As such, there exists a need for additional large-scale randomized controlled trials with well-defined parameters for the evaluation of clinical outcomes. Until the completion of such trials, titration of supplemental O2 to normoxia is advised to avoid the negative effects of both hyperoxia and hypoxia in acutely ill adult patients. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. METHODS A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents. RESULTS Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P less then .001). However, ARDS mortalities in the hospital and ICUs were not affected. CONCLUSIONS These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject’s total CO2 production (V̇CO2 ). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n = 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n = 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n = 6) that occurred during the test study. RESULTS The ratio of extracorporeal CO2 removal to the subjects’ V̇CO2 was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total V̇CO2 and ventilatory ratio increased steadily, whereas PaO2 /FIO2 was higher in subjects with apnea compared to intermediate RSBI ≤105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema. selleck chemicals Copyright © 2020 by Daedalus Enterprises.