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: STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications , which cause significant postoperative morbidity and prolong hospitalization , compared to patients who undergo other types of surgery . We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure ( nCPAP ) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization . DESIGN Prospect i ve r and omized clinical trial . SETTING Surgical ICU of a university hospital . PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta , of whom 6 patients were excluded because they had received prolonged mechanical ventilation . INTERVENTIONS Following extubation in the ICU , nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group ( n = 25 ) . Subjects in the control group ( n = 25 ) received st and ard treatment including intermittent nCPAP ( 10 cm H2O for 10 min ) every 4 h. MEASUREMENTS AND RESULTS In the study group , nCPAP was applied for a mean ( + /- SD ) duration of 23 + /- 3 h at an airway pressure of 10 + /- 1 cm H2O , which improved pulmonary oxygen transfer without altering hemodynamics ( ie , heart rate , mean arterial BP , and central venous pressure ) . The application of nCPAP was associated with fewer pulmonary complications ( Pa(O2)/fraction of inspired oxygen [ F(IO2 ) ] < 100 , atelectasis , pneumonia , reintubation rate ) compared to the control group ( 7 of 25 patients vs 24 of 25 subjects , respectively ; p = 0.019 ) . The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group ( 8 + /- 1 vs 12 + /- 2 days , respectively ; difference not significant ) , while the mean length of hospital stay was shorter with nCPAP therapy ( 22 + /- 2 vs 34 + /- 5 days , respectively ; p = 0.048 ) . CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms . Thus , it can be recommended as a st and ard treatment procedure for this patient group STUDY OBJECTIVES To investigate the short-term effects of noninvasive ventilatory support ( NIVS ) on pulmonary gas exchange , ventilatory pattern , systemic hemodynamics , and pleural air leaks in patients su bmi tted to elective lung resection . DESIGN Prospect i ve , r and omized , parallel , and controlled investigation . SETTING Thoracic Surgery Unit , Hospital Universitari Son Dureta , Palma Mallorca , Spain . PATIENTS Nineteen patients electively su bmi tted to lung resection because of varied clinical reasons . INTERVENTIONS Medical therapy was st and ardized for all patients . Ten subjects received NIVS with a nasal ventilatory support system ( BiPAP ) during 1 h ( study group ) . The remaining nine individuals constituted the control group . MEASUREMENTS AND RESULTS Arterial blood gases , ventilatory pattern , systemic hemodynamics , and pleural air leaks were measured . Before surgery , there were no significant clinical or functional differences between groups . After surgery , and compared with preoperative measures , PaO2 decreased significantly ( p<0.01 ) and to the same extent both in the study group ( 85.7+/-2.8 to 68.0+/-2.7 mm Hg ) and the control group ( 83.6+/-2.5 to 67.3+/-2.6 mm Hg ) . In the study group , NIVS increased PaO2 ( to 76.7+/-3.0 mm Hg ; p<0.05 ) and decreased alveolar to arterial oxygen pressure gradient ( P[A-a]O2 ) ( 27.2+/-2.7 to 17.6+/-2.3 mm Hg ; p<0.05 ) . This latter effect was still present 1 h after withdrawing NIVS . By contrast , PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study . PaCO2 , the ventilatory pattern , and systemic hemodynamics did not change significantly throughout the study in any group . Importantly , NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks . CONCLUSIONS Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients su bmi tted to lung resectional surgery BACKGROUND Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery . This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure ( nCPAP ) compared with st and ard treatment . The primary end points were pulmonary adverse effects defined as hypoxemia ( Pao(2)/fraction of inspired oxygen [ Fio(2 ) ] < 100 ) , pneumonia , and reintubation . The secondary end point was the readmission rate to the ICU or intermediate care unit ( IMCU ) . METHODS We prospect ively r and omized 500 patients scheduled for elective cardiac surgery . Following extubation either in the operating room ( early ) or in the ICU ( late ) , patients were allocated to st and ard treatment ( control ) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP ( study ) at an airway pressure of 10 cm H(2)O for at least 6 h. RESULTS Prophylactic nCPAP significantly improved arterial oxygenation ( Pao(2)/Fio(2 ) ) without altering heart rate and mean arterial BP . Pulmonary complications including hypoxemia ( defined as Pao(2)/Fio(2 ) < 100 ) , pneumonia , and reintubation rate were reduced in study patients compared to controls ( 12 of 232 patients vs 25 of 236 patients , respectively ; p = 0.03 ) . The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients ( 7 of 232 patients vs 14 of 236 patients , respectively ; p = 0.03 ) . CONCLUSIONS The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation , reduced the incidence of pulmonary complications including pneumonia and reintubation rate , and reduced readmission rate to the ICU or IMCU . Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection OBJECTIVE To evaluate the feasibility and outcomes of protocol -driven noninvasive mechanical ventilation in patients with acute respiratory failure ( ARF ) after cardiac surgery . METHODS From 2001 to 2004 , a total of 2428 cardiac surgery patients admitted to our intensive care unit were observed . After exclusion of patients who received tracheostomy or were discharged while still on mechanical ventilation , 2261 patients with spontaneous breathing were further evaluated for ARF . Patients diagnosed with ARF were treated with intermittent noninvasive mechanical ventilation ( NIV ) if possible . Risk factors for the development of postoperative ARF as well as outcomes in patients with and without ARF were analyzed . RESULTS In 2261 spontaneously breathing postoperative cardiac surgical patients after primarily successful extubation , 799 patients ( 35 % ) were diagnosed with ARF . Fifty-six patients ( 7 % ) did not tolerate NIV treatment . In 743 patients ( 33 % ) intermittent NIV was performed . In patients with ARF , ejection fraction was lower , combined cardiac surgical procedures were more frequent , postoperative mechanical ventilation time was longer , and the severity of illness score ( SAPS II ) was higher ( P < .05 ) . The duration of catecholamine support was longer , and the transfusion rate was higher in the NIV group ( P < .05 ) ; however , mortality did not differ between patients with ARF treated by NIV and patients without ARF . CONCLUSION Our study demonstrates the feasibility of NIV in patients after cardiac surgery . These results might suggest that NIV should be considered as first-line ventilatory support in ARF after cardiac surgery . A large r and omized trial is warranted to confirm these findings OBJECTIVE to show the benefits of the use of non-invasive positive pressure ventilation ( NPPV ) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery . METHODS A prospect i ve , r and omized and controlled study was performed involving 100 consecutive patients su bmi tted to coronary artery bypass grafting or valve surgery . The subjects were admitted into the Intensive Care Unit ( ICU ) under mechanical ventilation and r and omized in a study group ( n=50 ) , which used NPPV with bilevel pressure for 30 minutes after extubation , and a control group ( n=50 ) which only used a nasal O2 catheter .  Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia , surgery and cardiopulmonary bypass , as well as the time required for weaning from invasive mechanical ventilation were analysed . The arterial blood gases and hemodynamic variables were also assessed before and after extubation . RESULTS The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2 . On comparing the groups , the PaO2 improved significantly ( p = 0.0009 ) with the use of NPPV for 30 minutes after extubation , but there was no statistically significant difference in the PaCO2 ( p = 0.557 ) . CONCLUSION The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery BACKGROUND : The aim of our study was to evaluate the pulmonary effects of noninvasive ventilation ( NIV ) with or without recruitment maneuver ( RM ) after open heart surgery . METHODS : One-hundred patients undergoing coronary artery bypass surgery were r and omized into four groups after the operation : 1 ) RM with sustained inflation during mechanical ventilation postoperatively ( RM group , n = 25 ) ; 2 ) RM combined with NIV applied for 1/2-h periods every 6 h in the first postoperative day after tracheal extubation ( RM-NIV group , n = 25 ) ; 3 ) NIV after tracheal extubation ( NIV group , n = 25 ) ; and 4 ) a control group consisting of patients receiving neither RM nor NIV ( control group , n = 25 ) . Pulmonary function tests , oxygenation index , and atelectasis on chest radiograph were evaluated and compared among the groups . RESULTS : RM provided higher arterial oxygen levels during mechanical ventilation and after tracheal extubation compared to other interventions . Oxygenation was better in the RM-NIV and NIV groups than in the control group ( P = 0.02 and P = 0.008 , respectively ) at the end of the study . The postoperative atelectasis score of the control group ( median : 1 ) was higher than those of the RM ( 1 ; P = 0.03 ) , RM-NIV ( 0 ; P < 0.01 ) and NIV ( 0 ; P < 0.01 ) groups . Pulmonary function of the NIV groups on postoperative day 2 was better than in the other groups , whereas the tests were similar among the groups on postoperative day 7 . CONCLUSIONS : NIV associated with RM provided better oxygenation both during and after the mechanical ventilation period . NIV either alone or in combination with RM provided lower atelectasis scores and better early pulmonary function tests compared to the control group , without a significant difference regarding the duration of mechanical ventilation , intensive care unit stay , and the length of hospitalization .  NIV combined with RM is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia Abstract . Objective : To evaluate non-invasive ventilation ( NIV ) prospect ively in 
    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: STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications , which cause significant postoperative morbidity and prolong hospitalization , compared to patients who undergo other types of surgery . We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure ( nCPAP ) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization . DESIGN Prospect i ve r and omized clinical trial . SETTING Surgical ICU of a university hospital . PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta , of whom 6 patients were excluded because they had received prolonged mechanical ventilation . INTERVENTIONS Following extubation in the ICU , nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group ( n = 25 ) . Subjects in the control group ( n = 25 ) received st and ard treatment including intermittent nCPAP ( 10 cm H2O for 10 min ) every 4 h. MEASUREMENTS AND RESULTS In the study group , nCPAP was applied for a mean ( + /- SD ) duration of 23 + /- 3 h at an airway pressure of 10 + /- 1 cm H2O , which improved pulmonary oxygen transfer without altering hemodynamics ( ie , heart rate , mean arterial BP , and central venous pressure ) . The application of nCPAP was associated with fewer pulmonary complications ( Pa(O2)/fraction of inspired oxygen [ F(IO2 ) ] < 100 , atelectasis , pneumonia , reintubation rate ) compared to the control group ( 7 of 25 patients vs 24 of 25 subjects , respectively ; p = 0.019 ) . The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group ( 8 + /- 1 vs 12 + /- 2 days , respectively ; difference not significant ) , while the mean length of hospital stay was shorter with nCPAP therapy ( 22 + /- 2 vs 34 + /- 5 days , respectively ; p = 0.048 ) . CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms . Thus , it can be recommended as a st and ard treatment procedure for this patient group STUDY OBJECTIVES To investigate the short-term effects of noninvasive ventilatory support ( NIVS ) on pulmonary gas exchange , ventilatory pattern , systemic hemodynamics , and pleural air leaks in patients su bmi tted to elective lung resection . DESIGN Prospect i ve , r and omized , parallel , and controlled investigation . SETTING Thoracic Surgery Unit , Hospital Universitari Son Dureta , Palma Mallorca , Spain . PATIENTS Nineteen patients electively su bmi tted to lung resection because of varied clinical reasons . INTERVENTIONS Medical therapy was st and ardized for all patients . Ten subjects received NIVS with a nasal ventilatory support system ( BiPAP ) during 1 h ( study group ) . The remaining nine individuals constituted the control group . MEASUREMENTS AND RESULTS Arterial blood gases , ventilatory pattern , systemic hemodynamics , and pleural air leaks were measured . Before surgery , there were no significant clinical or functional differences between groups . After surgery , and compared with preoperative measures , PaO2 decreased significantly ( p<0.01 ) and to the same extent both in the study group ( 85.7+/-2.8 to 68.0+/-2.7 mm Hg ) and the control group ( 83.6+/-2.5 to 67.3+/-2.6 mm Hg ) . In the study group , NIVS increased PaO2 ( to 76.7+/-3.0 mm Hg ; p<0.05 ) and decreased alveolar to arterial oxygen pressure gradient ( P[A-a]O2 ) ( 27.2+/-2.7 to 17.6+/-2.3 mm Hg ; p<0.05 ) . This latter effect was still present 1 h after withdrawing NIVS . By contrast , PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study . PaCO2 , the ventilatory pattern , and systemic hemodynamics did not change significantly throughout the study in any group . Importantly , NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks . CONCLUSIONS Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients su bmi tted to lung resectional surgery BACKGROUND Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery . This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure ( nCPAP ) compared with st and ard treatment . The primary end points were pulmonary adverse effects defined as hypoxemia ( Pao(2)/fraction of inspired oxygen [ Fio(2 ) ] < 100 ) , pneumonia , and reintubation . The secondary end point was the readmission rate to the ICU or intermediate care unit ( IMCU ) . METHODS We prospect ively r and omized 500 patients scheduled for elective cardiac surgery . Following extubation either in the operating room ( early ) or in the ICU ( late ) , patients were allocated to st and ard treatment ( control ) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP ( study ) at an airway pressure of 10 cm H(2)O for at least 6 h. RESULTS Prophylactic nCPAP significantly improved arterial oxygenation ( Pao(2)/Fio(2 ) ) without altering heart rate and mean arterial BP . Pulmonary complications including hypoxemia ( defined as Pao(2)/Fio(2 ) < 100 ) , pneumonia , and reintubation rate were reduced in study patients compared to controls ( 12 of 232 patients vs 25 of 236 patients , respectively ; p = 0.03 ) . The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients ( 7 of 232 patients vs 14 of 236 patients , respectively ; p = 0.03 ) . CONCLUSIONS The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation , reduced the incidence of pulmonary complications including pneumonia and reintubation rate , and reduced readmission rate to the ICU or IMCU . Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection OBJECTIVE To evaluate the feasibility and outcomes of protocol -driven noninvasive mechanical ventilation in patients with acute respiratory failure ( ARF ) after cardiac surgery . METHODS From 2001 to 2004 , a total of 2428 cardiac surgery patients admitted to our intensive care unit were observed . After exclusion of patients who received tracheostomy or were discharged while still on mechanical ventilation , 2261 patients with spontaneous breathing were further evaluated for ARF . Patients diagnosed with ARF were treated with intermittent noninvasive mechanical ventilation ( NIV ) if possible . Risk factors for the development of postoperative ARF as well as outcomes in patients with and without ARF were analyzed . RESULTS In 2261 spontaneously breathing postoperative cardiac surgical patients after primarily successful extubation , 799 patients ( 35 % ) were diagnosed with ARF . Fifty-six patients ( 7 % ) did not tolerate NIV treatment . In 743 patients ( 33 % ) intermittent NIV was performed . In patients with ARF , ejection fraction was lower , combined cardiac surgical procedures were more frequent , postoperative mechanical ventilation time was longer , and the severity of illness score ( SAPS II ) was higher ( P < .05 ) . The duration of catecholamine support was longer , and the transfusion rate was higher in the NIV group ( P < .05 ) ; however , mortality did not differ between patients with ARF treated by NIV and patients without ARF . CONCLUSION Our study demonstrates the feasibility of NIV in patients after cardiac surgery . These results might suggest that NIV should be considered as first-line ventilatory support in ARF after cardiac surgery . A large r and omized trial is warranted to confirm these findings OBJECTIVE to show the benefits of the use of non-invasive positive pressure ventilation ( NPPV ) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery . METHODS A prospect i ve , r and omized and controlled study was performed involving 100 consecutive patients su bmi tted to coronary artery bypass grafting or valve surgery . The subjects were admitted into the Intensive Care Unit ( ICU ) under mechanical ventilation and r and omized in a study group ( n=50 ) , which used NPPV with bilevel pressure for 30 minutes after extubation , and a control group ( n=50 ) which only used a nasal O2 catheter .  Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia , surgery and cardiopulmonary bypass , as well as the time required for weaning from invasive mechanical ventilation were analysed . The arterial blood gases and hemodynamic variables were also assessed before and after extubation . RESULTS The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2 . On comparing the groups , the PaO2 improved significantly ( p = 0.0009 ) with the use of NPPV for 30 minutes after extubation , but there was no statistically significant difference in the PaCO2 ( p = 0.557 ) . CONCLUSION The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery BACKGROUND : The aim of our study was to evaluate the pulmonary effects of noninvasive ventilation ( NIV ) with or without recruitment maneuver ( RM ) after open heart surgery . METHODS : One-hundred patients undergoing coronary artery bypass surgery were r and omized into four groups after the operation : 1 ) RM with sustained inflation during mechanical ventilation postoperatively ( RM group , n = 25 ) ; 2 ) RM combined with NIV applied for 1/2-h periods every 6 h in the first postoperative day after tracheal extubation ( RM-NIV group , n = 25 ) ; 3 ) NIV after tracheal extubation ( NIV group , n = 25 ) ; and 4 ) a control group consisting of patients receiving neither RM nor NIV ( control group , n = 25 ) . Pulmonary function tests , oxygenation index , and atelectasis on chest radiograph were evaluated and compared among the groups . RESULTS : RM provided higher arterial oxygen levels during mechanical ventilation and after tracheal extubation compared to other interventions . Oxygenation was better in the RM-NIV and NIV groups than in the control group ( P = 0.02 and P = 0.008 , respectively ) at the end of the study . The postoperative atelectasis score of the control group ( median : 1 ) was higher than those of the RM ( 1 ; P = 0.03 ) , RM-NIV ( 0 ; P < 0.01 ) and NIV ( 0 ; P < 0.01 ) groups . Pulmonary function of the NIV groups on postoperative day 2 was better than in the other groups , whereas the tests were similar among the groups on postoperative day 7 . CONCLUSIONS : NIV associated with RM provided better oxygenation both during and after the mechanical ventilation period . NIV either alone or in combination with RM provided lower atelectasis scores and better early pulmonary function tests compared to the control group , without a significant difference regarding the duration of mechanical ventilation , intensive care unit stay , and the length of hospitalization .  NIV combined with RM is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia Abstract . Objective : To evaluate non-invasive ventilation ( NIV ) prospect ively in 
    Output:
    