Technology is changing: is the continuing professional development also changing?

This paper considers the impact of the new information environment on the scientific communication. Reading behavior changes: today, we browse, scan, watch, receive an impression of something. The new reading habits are not simply determined by the new tools; they are rather influenced by the need to produce and share data and information, using personalized and mobile devices. Also the content formats change: researchers, clinicians, and nurses produce texts, figures, tables, photos, videos, tweets, blog posts and they share them to readers that have to collect, appraise, recombine and - most importantly - contextualize the information. This "continuous partial production" is consistent with a "continuous partial utilization" of data; this is a risk, but it is also an opportunity. On the one side, we risk a self-referential, individualized learning process; on the other side, we can enjoy the extraordinary chance to build a "shared learning environment", able to give a comprehensive solution to the challenges experienced by the health systems. Medical journals survive as valuable media to organize data and information; the new social web tools should support the traditional publishing patterns, to enhance the sharing of information, to help the appraisal of data, and to move forward new communities of learners.     

Non-invasive ventilation and continuous positive pressure ventilation in emergency departments: where are we now?

A number of emergency departments have introduced non-invasive positive pressure ventilation (NIV) and continuous positive airway pressure (CPAP) for patients presenting with acute respiratory failure. It is thought that early non-invasive respiratory support will avoid the need for invasive ventilation in many cases. This literature review studied current knowledge of NIV and CPAP in the acute setting with the aim of creating simple guidelines for hospitals initiating early non-invasive ventilatory support in emergency departments. NIV is effective in reducing intubation and mortality rates in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and CPAP is effective in reducing mortality in patients with cardiogenic pulmonary oedema, especially when implemented early. NIV and CPAP were also found to be effective in some other causes of acute respiratory failure. There is a role for non-invasive respiratory support in emergency departments.     

Noninvasive positive pressure ventilation in acute respiratory failure: does it improve outcomes?

Studies have shown that noninvasive positive pressure ventilation (NPPV) is well tolerated and safe, and that it improves oxygenation in some patients with acute respiratory failure. By obviating the need for endotracheal intubation in certain conditions, it results in fewer complications, shorter hospital stays, and consequently, lower mortality rates and costs of care.     

Control of breathing during mechanical ventilation: who is the boss?

Over the past decade, concepts of control of breathing have increasingly moved from being theoretical concepts to "real world" applied science. The purpose of this review is to examine the basics of control of breathing, discuss the bidirectional relationship between control of breathing and mechanical ventilation, and critically assess the application of this knowledge at the patient's bedside. The principles of control of breathing remain under-represented in the training curriculum of respiratory therapists and pulmonologists, whereas the day-to-day bedside application of the principles of control of breathing continues to suffer from a lack of outcomes-based research in the intensive care unit. In contrast, the bedside application of the principles of control of breathing to ambulatory subjects with sleep-disordered breathing has out-stripped that in critically ill patients. The evolution of newer technologies, faster real-time computing abilities, and miniaturization of ventilator technology can bring the concepts of control of breathing to the bedside and benefit the critically ill patient. However, market forces, lack of scientific data, lack of research funding, and regulatory obstacles need to be surmounted.     

Effectiveness of WBC reduction in neonates: what is the evidence of benefit?

BACKGROUND: The presence of WBCs in RBCs is thought to be associated with a number of significant adverse effects in recipients. In adults, WBC reduction has been shown to reduce the frequency of HLA alloimmunization, CMV and HTLV infections, and febrile nonhemolytic transfusion reactions. However, neonates are unique, given that they have an immature immune system and are frequently transfused with RBCs. Thus, the aims of this systematic review were to determine whether WBC reduction of RBCs transfused to neonates decreases the transmission of CMV, reduces the ability to develop HLA antibodies, or reduces the risk of immunomodulation. In addition, nosocomial infection, mortality, and duration of stay were identified and analyzed. STUDY DESIGN AND METHODS: All studies of WBC reduction were identified by a systematic review of the literature. Studies meeting the inclusion criteria were grouped based on study outcome. Where appropriate, studies were pooled to obtain an overall measure of effect. RESULTS: Nine eligible studies were identified from the systematic literature search, and six were deemed evaluable. Two studies evaluated WBC reduction and the development of CMV, with different results. The pooled OR was 0.19 (95% Cl, 0.01-3.41), suggesting a clinical but nonsignificant effect. Two studies evaluated WBC reduction and HLA antibody development. As with CMV, the two studies were not congruent in their results. The pooled OR was 0.17 (95% Cl, 0.01-2.43). As for immunomodulation, two small studies presented evidence of a statistically significant change in lymphocyte subsets. No studies were identified with a primary objective of evaluating the impact of WBC reduction on nosocomial infection, mortality, or duration of stay. CONCLUSION: Current evidence suggests that WBC reduction may be effective in neonates; however, further studies are needed. The lack of convincing data and the significant cost of WBC reduction mandate evaluations to determine the clinical and economic impact.     

Noninvasive ventilation and the upper airway: should we pay more attention?

In an effort to reduce the complications related to invasive ventilation, the use of noninvasive ventilation (NIV) has increased over the last years in patients with acute respiratory failure. However, failure rates for NIV remain high in specific patient categories. Several studies have identified factors that contribute to NIV failure, including low experience of the medical team and patient–ventilator asynchrony. An important difference between invasive ventilation and NIV is the role of the upper airway. During invasive ventilation the endotracheal tube bypasses the upper airway, but during NIV upper airway patency may play a role in the successful application of NIV. In response to positive pressure, upper airway patency may decrease and therefore impair minute ventilation. This paper aims to discuss the effect of positive pressure ventilation on upper airway patency and its possible clinical implications, and to stimulate research in this field.     

Noninvasive positive pressure ventilation for respiratory failure caused by exacerbations of chronic obstructive pulmonary disease: a standard of care?

This editorial comments on a meta-analysis of the use of noninvasive positive pressure ventilation to treat patients with acute respiratory failure caused by chronic obstructive pulmonary disease (COPD) exacerbations published in the British Medical Journal earlier this year. Based on its analysis of seven randomized controlled trials that met pre-specified criteria, the meta-analysis demonstrated highly significant benefits of noninvasive positive pressure ventilation in COPD patients, including a reduction in a combined end-point consisting of death and endotracheal intubation. The editorial argues that, based on the strength of this and other evidence, noninvasive positive pressure ventilation to treat selected patients with acute respiratory failure due to COPD exacerbations should now be considered a standard of care.