human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure OBJECTIVE To discuss the optimal time for extubation and sequential non-invasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation .  METHODS 24 patients received invasive ventilation for 3 days were r and omly assigned to receive noninvasive ventilation ( study group ) or to continue the weaning process with invasive ventilation ( control group ) . The incidence of ventilator-associated pneumonia ( VAP ) , the incidence of death , the duration of ventilation , the hospitalization were analyzed in two groups . RESULTS Between study group and control group , the incidence of VAP was 0/12 vs 7/12 , P = 0.027 ; the incidence of death was 0/12 vs 3/12 , P = 0.217 ; the continued duration of ventilation after invasive ventilation for 3 days was ( 7 + /- 5 ) days vs ( 15 + /- 12 ) days , P < 0.05 ; the hospitalization was ( 16 + /- 6 ) days vs ( 25 + /- 12 ) days , P < 0.05 , respectively . CONCLUSIONS In COPD patients with exacerbated respiratory failure who received invasive ventilation  , invasive ventilation for 3 days followed by noninvasive ventilation may decrease the incidence of VAP , shorten the duration of ventilation and hospitalization Background : Endotracheal intubation and mechanical ventilation ( MV ) are often needed in patients of chronic obstructive pulmonary disease ( COPD ) with acute hypercapnic respiratory failure . The rate of weaning failure is high and prolonged MV increases intubation associated complications . Objective : To evaluate the role of Noninvasive ventilation ( NIV ) in weaning patients of chronic obstructive pulmonary disease ( COPD ) from MV , after T piece trial failure . Design : A prospect i ve , r and omized , controlled study was conducted in a tertiary care centre . 30 patients of acute exacerbation of COPD with acute on chronic hypercapnic respiratory failure , who were mechanically ventilated , were included in the study A T-piece weaning trial was attempted once the patients achieved satisfactory clinical and biochemical parameters . After T-piece failure , defined as pH < 7.35 , PaCO2 > 50 mmHg , PaO2 < 50 mmHg , HR > 100/min , RR > 35 , patients were r and omized to receive either NIV or PSV . Results : Demography , severity of disease and clinical profiles were similar in both groups . No significant difference between the two groups in duration of MV ( 6.20 ± 5.20 days vs. 7.47 ± 6.38 days , P > 0.05 ) , duration of weaning ( 35.17 ± 16.98 and 47.05 ± 20.98 hours , P > 0.05 ) or duration of ICU stay ( 8.47 ± 4.79 and 10.80 ± 5.28 days , P > 0.05 ) in Gp I and Gp II , respectively . Five patients developed VAP in the PSV group , where as only one patient had pneumonia in the NIV group . Lesser number of deaths in the NIV group at discharge from ICU ( 3 vs. 5 patients , respectively ) and at 30 days ( 5 vs. 9 patients , respectively ) , it did not achieve statistical significance ( P > 0.05 ) . Conclusion : NIV is as useful as PSV in weaning and can be better in weaning failure especially in COPD for earlier weaning , decrease ICU stay , complications and mortality Purpose The use of noninvasive ventilation ( NIV ) to facilitate discontinuation of mechanical ventilation in patients with acute hypoxemic respiratory failure ( hypoxemic ARF ) has never been explored . This pilot study aims to assess the feasibility of early extubation followed by immediate NIV , compared conventional weaning , in patients with resolving hypoxemic ARF . Methods Twenty consecutive hypoxemic patients were r and omly assigned to receive either conventional weaning or NIV . The changes in arterial blood gases and respiratory rate were compared between the two groups at 1 , 12 , 24 and 48 h. Differences in the rate of extubation failure , ICU and hospital mortality , number of invasive-ventilation-free-days at day 28 , septic complications , number of tracheotomies , days and rates of continuous intravenous sedation , and ICU length of stay were also determined . Results No patient interrupted the study protocol . Arterial blood gases were similar during invasive mechanical ventilation , 1 h after NIV application following extubation , and after 12 , 24 and 48 h. Respiratory rate was higher after 1 h in the NIV group , but no different after 12 , 24 and 48 h. The number of invasive-ventilation-free-days at day 28 was 20 ± 8 ( min = 0 , max = 25 ) days in the treatment group and 10 ± 9 ( min = 0 , max = 25 ) days in the control group ( p = 0.014 ) . The rate of extubation failure , ICU and hospital mortality , tracheotomies , septic complications , days and rates of continuous sedation , and ICU length of stay were not significantly different between the two groups . Conclusions In a highly experienced centre NIV may be used to facilitate discontinuation of mechanical ventilation in selected patients with resolving hypoxemic ARF Prolonged duration of endotracheal mechanical ventilation ( ETMV )  is associated with an increased morbidity and mortality in intensive care unit ( ICU ) patients . The aim of this study was to assess the usefulness of noninvasive ventilation ( NIV ) as a systematic extubation and weaning technique to reduce the duration of ETMV in acute-on-chronic respiratory failure ( ACRF ) . Among 53 consecutively intubated patients admitted for ACRF , we conducted a prospect i ve , r and omized controlled trial of weaning in 33 patients who failed a 2-h T-piece weaning trial ( 2 h-WT ) although they met simple criteria for weaning . Conventional invasive pressure support ventilation ( IPSV ) was used as the control weaning technique in 16 patients ( IPSV group ) , and NIV was applied immediately after extubation in 17 patients ( NIV group ) . The two weaning groups were similar for type of chronic respiratory failure ( CRF ) , pulmonary function data , age , Simplified Acute Physiology Score ( SAPS II ) , and severity of ACRF on admission . The characteristics of the two groups were also similar at r and omization . In the IPSV group , 12 of 16 patients ( 75 % ) were successfully weaned and extubated , versus 13 of 17 ( 76.5 % ) in the NIV group ( p = NS ) . NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during 2 h-WT ( p < 0.05 ) . The duration of ETMV was significantly shorter in the NIV ( 4.56 + /- 1.85 d ) than in the IPSV group ( 7.69 + /- 3.79 d ) ( p = 0 . 004 ) . NIV also reduced the mean period of daily ventilatory support , but increased the total duration of ventilatory support related to weaning ( 3.46 + /- 1.42 d , versus 11.54 + /- 5.24 d with NIV ; p = 0 . 0001 ) . Most patients in the IPSV group developed complications related to ETMV and /or the weaning process , but the difference was not significant ( nine of 16 versus six of 17 ) . The duration s of ICU and hospital stays and the 3-mo survival were similar in the two groups . In conclusion , NIV permits earlier removal of the endotracheal tube than with conventional IPSV , and reduces the duration of daily ventilatory support without increasing the risk of weaning failures .  NIV should be considered as a new and useful systematic approach to weaning in patients with ACRF who are difficult to wean To assess the efficacy of noninvasive ventilation ( NIV ) in patients with persistent weaning failure , we conducted a prospect i ve , r and omized , controlled trial in 43 mechanically ventilated patients who had failed a weaning trial for 3 consecutive days . This trial was stopped after a planned interim analysis . Patients were r and omly extubated , receiving NIV ( n = 21 ) , or remained intubated following a conventional-weaning approach consisting of daily weaning attempts ( n = 22 ) . Compared with the conventional-weaning group , the noninvasive-ventilation group had shorter periods of invasive ventilation ( through tracheal intubation ) ( 9.5 + /- 8.3 vs. 20.1 + /- 13.1 days , p = 0.003 ) and intensive care unit ( ICU ) ( 14.1 + /- 9.2 vs. 25.0 + /- 12.5 days , p = 0.002 ) and hospital stays ( 27.8 + /- 14.6 vs. 40.8 + /- 21.4 days , p = 0.026 ) , less need for tracheotomy to withdraw ventilation ( 1 , 5 % vs. 13 , 59 % , p < 0.001 ) , lower incidence of nosocomial pneumonia ( 5 , 24 % vs. 13 , 59 % , p = 0.042 ) and septic shock ( 2 , 10 % vs. 9 , 41 % , p = 0.045 ) , and increased ICU ( 19 , 90 % vs. 13 , 59 % , p = 0.045 ) and 90-day survival ( p = 0.044 ) . The conventional-weaning approach was an independent risk factor of decreased ICU ( odds ratio : 6.6 ; p = 0.035 ) and 90-day survival ( odds ratio : 3.5 ; p = 0.018 ) . Earlier extubation with NIV results in shorter mechanical ventilation and length of stay , less need for tracheotomy , lower incidence of complications , and improved survival in these patients BACKGROUND AND METHODS The role of noninvasive positive-pressure ventilation delivered through a face mask in patients with acute respiratory failure is uncertain . We conducted a prospect i ve , r and omized trial of noninvasive positive-pressure ventilation as compared with endotracheal intubation with conventional mechanical ventilation in 64 patients with hypoxemic acute respiratory failure who required mechanical ventilation . RESULTS Within the first hour of ventilation , 20 of 32 patients ( 62 percent ) in the noninvasive-ventilation group and 15 of 32 ( 47 percent ) in the conventional-ventilation group had an improved ratio of the partial pressure of arterial oxygen to 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure OBJECTIVE To discuss the optimal time for extubation and sequential non-invasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation .  METHODS 24 patients received invasive ventilation for 3 days were r and omly assigned to receive noninvasive ventilation ( study group ) or to continue the weaning process with invasive ventilation ( control group ) . The incidence of ventilator-associated pneumonia ( VAP ) , the incidence of death , the duration of ventilation , the hospitalization were analyzed in two groups . RESULTS Between study group and control group , the incidence of VAP was 0/12 vs 7/12 , P = 0.027 ; the incidence of death was 0/12 vs 3/12 , P = 0.217 ; the continued duration of ventilation after invasive ventilation for 3 days was ( 7 + /- 5 ) days vs ( 15 + /- 12 ) days , P < 0.05 ; the hospitalization was ( 16 + /- 6 ) days vs ( 25 + /- 12 ) days , P < 0.05 , respectively . CONCLUSIONS In COPD patients with exacerbated respiratory failure who received invasive ventilation  , invasive ventilation for 3 days followed by noninvasive ventilation may decrease the incidence of VAP , shorten the duration of ventilation and hospitalization Background : Endotracheal intubation and mechanical ventilation ( MV ) are often needed in patients of chronic obstructive pulmonary disease ( COPD ) with acute hypercapnic respiratory failure . The rate of weaning failure is high and prolonged MV increases intubation associated complications . Objective : To evaluate the role of Noninvasive ventilation ( NIV ) in weaning patients of chronic obstructive pulmonary disease ( COPD ) from MV , after T piece trial failure . Design : A prospect i ve , r and omized , controlled study was conducted in a tertiary care centre . 30 patients of acute exacerbation of COPD with acute on chronic hypercapnic respiratory failure , who were mechanically ventilated , were included in the study A T-piece weaning trial was attempted once the patients achieved satisfactory clinical and biochemical parameters . After T-piece failure , defined as pH < 7.35 , PaCO2 > 50 mmHg , PaO2 < 50 mmHg , HR > 100/min , RR > 35 , patients were r and omized to receive either NIV or PSV . Results : Demography , severity of disease and clinical profiles were similar in both groups . No significant difference between the two groups in duration of MV ( 6.20 ± 5.20 days vs. 7.47 ± 6.38 days , P > 0.05 ) , duration of weaning ( 35.17 ± 16.98 and 47.05 ± 20.98 hours , P > 0.05 ) or duration of ICU stay ( 8.47 ± 4.79 and 10.80 ± 5.28 days , P > 0.05 ) in Gp I and Gp II , respectively . Five patients developed VAP in the PSV group , where as only one patient had pneumonia in the NIV group . Lesser number of deaths in the NIV group at discharge from ICU ( 3 vs. 5 patients , respectively ) and at 30 days ( 5 vs. 9 patients , respectively ) , it did not achieve statistical significance ( P > 0.05 ) . Conclusion : NIV is as useful as PSV in weaning and can be better in weaning failure especially in COPD for earlier weaning , decrease ICU stay , complications and mortality Purpose The use of noninvasive ventilation ( NIV ) to facilitate discontinuation of mechanical ventilation in patients with acute hypoxemic respiratory failure ( hypoxemic ARF ) has never been explored . This pilot study aims to assess the feasibility of early extubation followed by immediate NIV , compared conventional weaning , in patients with resolving hypoxemic ARF . Methods Twenty consecutive hypoxemic patients were r and omly assigned to receive either conventional weaning or NIV . The changes in arterial blood gases and respiratory rate were compared between the two groups at 1 , 12 , 24 and 48 h. Differences in the rate of extubation failure , ICU and hospital mortality , number of invasive-ventilation-free-days at day 28 , septic complications , number of tracheotomies , days and rates of continuous intravenous sedation , and ICU length of stay were also determined . Results No patient interrupted the study protocol . Arterial blood gases were similar during invasive mechanical ventilation , 1 h after NIV application following extubation , and after 12 , 24 and 48 h. Respiratory rate was higher after 1 h in the NIV group , but no different after 12 , 24 and 48 h. The number of invasive-ventilation-free-days at day 28 was 20 ± 8 ( min = 0 , max = 25 ) days in the treatment group and 10 ± 9 ( min = 0 , max = 25 ) days in the control group ( p = 0.014 ) . The rate of extubation failure , ICU and hospital mortality , tracheotomies , septic complications , days and rates of continuous sedation , and ICU length of stay were not significantly different between the two groups . Conclusions In a highly experienced centre NIV may be used to facilitate discontinuation of mechanical ventilation in selected patients with resolving hypoxemic ARF Prolonged duration of endotracheal mechanical ventilation ( ETMV )  is associated with an increased morbidity and mortality in intensive care unit ( ICU ) patients . The aim of this study was to assess the usefulness of noninvasive ventilation ( NIV ) as a systematic extubation and weaning technique to reduce the duration of ETMV in acute-on-chronic respiratory failure ( ACRF ) . Among 53 consecutively intubated patients admitted for ACRF , we conducted a prospect i ve , r and omized controlled trial of weaning in 33 patients who failed a 2-h T-piece weaning trial ( 2 h-WT ) although they met simple criteria for weaning . Conventional invasive pressure support ventilation ( IPSV ) was used as the control weaning technique in 16 patients ( IPSV group ) , and NIV was applied immediately after extubation in 17 patients ( NIV group ) . The two weaning groups were similar for type of chronic respiratory failure ( CRF ) , pulmonary function data , age , Simplified Acute Physiology Score ( SAPS II ) , and severity of ACRF on admission . The characteristics of the two groups were also similar at r and omization . In the IPSV group , 12 of 16 patients ( 75 % ) were successfully weaned and extubated , versus 13 of 17 ( 76.5 % ) in the NIV group ( p = NS ) . NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during 2 h-WT ( p < 0.05 ) . The duration of ETMV was significantly shorter in the NIV ( 4.56 + /- 1.85 d ) than in the IPSV group ( 7.69 + /- 3.79 d ) ( p = 0 . 004 ) . NIV also reduced the mean period of daily ventilatory support , but increased the total duration of ventilatory support related to weaning ( 3.46 + /- 1.42 d , versus 11.54 + /- 5.24 d with NIV ; p = 0 . 0001 ) . Most patients in the IPSV group developed complications related to ETMV and /or the weaning process , but the difference was not significant ( nine of 16 versus six of 17 ) . The duration s of ICU and hospital stays and the 3-mo survival were similar in the two groups . In conclusion , NIV permits earlier removal of the endotracheal tube than with conventional IPSV , and reduces the duration of daily ventilatory support without increasing the risk of weaning failures .  NIV should be considered as a new and useful systematic approach to weaning in patients with ACRF who are difficult to wean To assess the efficacy of noninvasive ventilation ( NIV ) in patients with persistent weaning failure , we conducted a prospect i ve , r and omized , controlled trial in 43 mechanically ventilated patients who had failed a weaning trial for 3 consecutive days . This trial was stopped after a planned interim analysis . Patients were r and omly extubated , receiving NIV ( n = 21 ) , or remained intubated following a conventional-weaning approach consisting of daily weaning attempts ( n = 22 ) . Compared with the conventional-weaning group , the noninvasive-ventilation group had shorter periods of invasive ventilation ( through tracheal intubation ) ( 9.5 + /- 8.3 vs. 20.1 + /- 13.1 days , p = 0.003 ) and intensive care unit ( ICU ) ( 14.1 + /- 9.2 vs. 25.0 + /- 12.5 days , p = 0.002 ) and hospital stays ( 27.8 + /- 14.6 vs. 40.8 + /- 21.4 days , p = 0.026 ) , less need for tracheotomy to withdraw ventilation ( 1 , 5 % vs. 13 , 59 % , p < 0.001 ) , lower incidence of nosocomial pneumonia ( 5 , 24 % vs. 13 , 59 % , p = 0.042 ) and septic shock ( 2 , 10 % vs. 9 , 41 % , p = 0.045 ) , and increased ICU ( 19 , 90 % vs. 13 , 59 % , p = 0.045 ) and 90-day survival ( p = 0.044 ) . The conventional-weaning approach was an independent risk factor of decreased ICU ( odds ratio : 6.6 ; p = 0.035 ) and 90-day survival ( odds ratio : 3.5 ; p = 0.018 ) . Earlier extubation with NIV results in shorter mechanical ventilation and length of stay , less need for tracheotomy , lower incidence of complications , and improved survival in these patients BACKGROUND AND METHODS The role of noninvasive positive-pressure ventilation delivered through a face mask in patients with acute respiratory failure is uncertain . We conducted a prospect i ve , r and omized trial of noninvasive positive-pressure ventilation as compared with endotracheal intubation with conventional mechanical ventilation in 64 patients with hypoxemic acute respiratory failure who required mechanical ventilation . RESULTS Within the first hour of ventilation , 20 of 32 patients ( 62 percent ) in the noninvasive-ventilation group and 15 of 32 ( 47 percent ) in the conventional-ventilation group had an improved ratio of the partial pressure of arterial oxygen to 
    Output:
    