Discussion: Adjunct therapies during mechanical ventilation: Airway clearance techniques, therapeutic aerosols, and gases

摘要

Maclntyre: In 1995 there was a consensus conference on innovations in mechanical ventilation,1 and one of the themes that came from that was that if you had an innovation that was not particularly risky or expensive, the required level of evidence for adopting it could be physiologic or intermediate types of outcomes. In contrast, an innovation with substantial risk or cost would not be recommended without support from a real outcomes study. That's my prologue to asking for your thoughts on INO, which is ridiculously expensive, has only transient benefits, and the RCTs to date have not shown any benefits or positive outcomes of any sort.2 The Canadian group3 even suggested there was a risk of renal failure. So if INO is both expensive and has risks, why do we even talk about it without the outcome evidence to support its use?