Is High Frequency Oscillatory Ventilation Really Dead?
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An interview with Neil MacIntyre, MD on Rescue Ventilation and Conducting Clinical Research
Neil MacIntyre, MD
Dr. Neil MacIntyre is Chief of Clinical Services and attending in pulmonary and critical care at Duke University. He was involved in the original ARDSNet trials, and an author on the 2004 N Engl J Med high vs low PEEP in ARDS study.
Tonna: I had heard that you felt that the trials done on the oscillator were not done as well as they could have been to show their strength. Is that fair to say?
MacIntyre: Yes, I had some problems with the way those two trials were done. I would have done them differently. In terms of running an oscillator, you have to know what you’re doing, because the settings and the control panel are not intuitive. For instance, you usually have to reduce the rate to improve CO2 clearance. You usually are dealing with fairly substantial mean airway pressures, so hemodynamic issues can be important. One of the problems I have with both of these trials—more with OSCAR than OSCILLATE—frequently there were centers that had very little experience with oscillators and even if they did, they didn’t have 24/7 coverage with experts in oscillation, and I think that can hamper the effectiveness of the oscillator in both of these trials.
Notes from the Chair
The summer has flown by, and October is getting closer as we are all anticipating a great time in Chicago for ACEP14. The Critical Care Medicine Section has been very busy with a few projects as well as preparing a very interesting section meeting.Read More »
The first project is a grant, together with our colleagues in the International Emergency Medicine Section. Ayan Sen has spearheaded this effort and secured a $4,000 ACEP section grant, along with Hani Mowafi and Janet Lin from the International Emergency Medicine Section. “Project PICC: Promoting an International Coalition in Critical Care” is the first part of a project designed to bring together physicians in critical care from around the world, including developing countries. We recognize that the academic efforts and discoveries based on first world medicine resources are not always (if ever) possible to expedite in most of the world. We also recognize that there are important findings from developing world medicine that may shed light on our practice. We will have Ayan describing this exciting project and its future prospects at the section meeting. You may want to get involved.
‘Sen’ timents: A Tryst with Global Emergency and Critical Care: Project PICC
On a recent trip to India, my country of origin, I heard that a relative in her 60s had passed away . . . she had pneumonia and sepsis. Her daughter, after complaining about a litany of perceived errors in her care, asked me with an air of inevitability “People don’t survive when they have septicemia…do they?” Read More »
I didn’t know how to answer the question. I stood and stared and mumbled something incoherently until it dawned on me . . . while we grapple with early goal-directed therapy, PROCESS, and whether to check venous saturation or central venous pressure in sepsis, the developing world paradigms may be a little different. A recent Indian Intensive Care Case Mix and Practice Patterns (INDICAPS) study found that one out of every eight patients in India die from infections contracted in ICUs. INDICAPS also found that 26% of the patients in ICUs contracted sepsis, 42.2% of them fatally.1
Critical Care Board Exam Calendar
Critical Care Board Dates at a Glance! Read More »
Application Cycle, Exam and Practice Path Dates for Internal Medicine, Anesthesia, Surgery and Neurocritical Care Pathways.