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Báo cáo y học: " Prophylactic positive end-expiratory pressure: are good intentions enough"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về y học đề tài: Prophylactic positive end-expiratory pressure: are good intentions enough? | Available online http ccforum.eom content 7 2 191 Letter Prophylactic positive end-expiratory pressure are good intentions enough Enrique Fernandez-Mondejar1 Ma Jesus Chavero2 and Juan Machado2 1 Cheif of ICU Servicio de Cuidados Críticos y Urgencias Hospital de Traumatología Hospital Universitario Virgen de las Nieves Granada Spain 2Resident ICU Servicio de Cuidados Críticos y Urgencias Hospital de Traumatología Hospital Universitario Virgen de las Nieves Granada Spain Correspondence Enrique Fernandez-Mondejar efermonde@hvn.sas.junta-andalucia.es Published online 18 December 2002 Critical Care 2003 7 191 DOI 10.1186 cc1869 This article is online at http ccforum.com content 7 2 191 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Few actions taken by intensivists are as effective and inexpensive as application of positive end-expiratory pressure PEEP . However the use of this ventilatory modality is highly susceptible to fashions and trends that are rarely supported by scientific evidence. Prophylactic PEEP can be considered an exception in that there is scientific evidence that it offers no benefit. Nevertheless we must confess that we use prophylactic PEEP. The issue is worthy of some reflection. At the end of the 1970s it was thought that PEEP not only improves hypoxaemia but also reduces the incidence of acute respiratory distress syndrome when used prophylactically 1 2 . At that time we generally used PEEP at 5cmH2O prophylactically in all patients with no contraindications no hypovolaemia no bullae on the chest radiogram no emphysema . This approach appeared less reasonable after the publication in 1984 of the influential report by Pepe and coworkers 3 which concluded that PEEP confers no protective effect. Several experimental studies published at the same time supported this new outlook 4 . Those reports brought about a change in attitude leading to a general consensus that prophylactic PEEP was of no utility and should therefore be .