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: Purpose Weaning from prolonged mechanical ventilation may be associated with mental discomfort . It is not known whether such discomfort is linked with the development of post-traumatic stress disorder ( PTSD ) . Accordingly , we investigated whether PTSD occurs in patients after weaning from prolonged ventilation .  We also determined whether administering a question naire would identify patients at risk for developing PTSD . Methods A prospect i ve longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation  was undertaken : 72 patients were studied 1 week after weaning , and 41 patients were studied again 3 months later . An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD . To assess for the presence of PTSD-related symptoms , the post-traumatic stress syndrome ( PTSS-10 ) question naire was administered 1 week after weaning and 3 months later . Results The psychologist diagnosed PTSD in 12 % of patients 3 months after ventilator weaning . Patients who developed PTSD were more likely to have a previous history of psychiatric disorders ( P < 0.02 ) . A PTSS-10 score > 20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later : sensitivity 1.0 ; specificity 0.76 ; area under the receiver-operating characteristic curve 0.91 . Conclusion PTSD was diagnosed in 12 % of patients who were weaned from prolonged ventilation . A PTSS-10 score > 20 one week after weaning identified patients diagnosed with PTSD 3 months later . This finding suggests that a simple question naire administered before hospital discharge can identify patients at risk for developing PTSD Objectives It is not known if proportional assist ventilation with load-adjustable gain factors ( PAV+ ) may be used as a mode of support in critically ill patients . The aim of this study was to examine the effectiveness of sustained use of PAV+ in critically ill patients and compare it with pressure support ventilation ( PS ) . Design and setting R and omized study in the intensive care unit of a university hospital . Methods A total of 208 critically ill patients mechanically ventilated on controlled modes for at least 36 h and meeting certain criteria were r and omized to receive either PS  ( n = 100 ) or  PAV+ ( n = 108 ) . Specific written algorithms were used to adjust the ventilator setting s in each mode . PAV+ or PS was continued for 48 h unless the patients met pre-defined criteria either for switching to controlled modes ( failure criteria ) or for breathing without ventilator assistance . Results Failure rate was significantly lower in PAV+ than that in PS ( 11.1 vs. 22.0 % , P = 0.040 , OR 0.443 , 95 % CI 0.206–0.952 ) . The proportion of patients exhibiting major patient – ventilator dyssynchronies at least during one occasion and after adjusting the initial ventilator setting s , was significantly lower in PAV+ than in PS ( 5.6 vs. 29.0 % , P < 0.001 , OR 0.1 , 95 % CI 0.06–0.4 ) . The proportion of patients meeting criteria for unassisted breathing did not differ between modes . Conclusions PAV+ may be used as a useful mode of support in critically ill patients . Compared to PS , PAV+ increases the probability of remaining on spontaneous breathing , while it considerably reduces the incidence of patient – ventilator asynchronies Purpose IntelliVent-ASV ® is a development of adaptive support ventilation ( ASV ) that automatically adjusts ventilation and oxygenation parameters . This study assessed the safety and efficacy of IntelliVent-ASV ® in se date d intensive care unit ( ICU ) patients with acute respiratory failure . Methods This prospect i ve r and omized crossover comparative study was conducted in a 12-bed ICU in a general hospital . Two periods of 2 h of ventilation in r and omly applied ASV or IntelliVent-ASV ® were compared in 50 se date d , passively ventilated patients . Tidal volume ( VT ) , respiratory rate ( RR ) , inspiratory pressure ( PINSP ) , SpO2 and ETCO2 were continuously monitored and recorded breath by breath . Mean values over the 2-h period were calculated . Respiratory mechanics , plateau pressure ( PPLAT ) and blood gas exchanges were measured at the end of each period . Results There was no safety issue requiring premature interruption of IntelliVent-ASV ® . Minute ventilation ( MV ) and VT decreased from 7.6 ( 6.5–9.5 ) to 6.8 ( 6.0–8.0 ) L/min ( p < 0.001 ) and from 8.3 ( 7.8–9.0 ) to 8.1 ( 7.7–8.6 ) mL/kg PBW ( p = 0.003 ) during IntelliVent-ASV ® as compared to ASV . PPLAT and FiO2 decreased from 24 ( 20–29 ) to 20 ( 19–25 ) cmH2O ( p = 0.005 ) and from 40 ( 30–50 ) to 30 ( 30–39 ) % ( p < 0.001 ) during IntelliVent-ASV ® as compared to ASV . RR , PINSP , and PEEP decreased as well during IntelliVent-ASV ® as compared to ASV . Respiratory mechanics , pH , PaO2 and PaO2/FiO2 ratio were not different but PaCO2 was slightly higher during IntelliVent-ASV ® as compared to ASV . Conclusions In passive patients with acute respiratory failure , IntelliVent-ASV ® was safe and able to ventilate patients with less pressure , volume and FiO2 while producing the same results in terms of oxygenation Introduction Patients undergoing mechanical ventilation ( MV ) are frequently administered prolonged and /or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV . We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV . Methods A double-blind r and omized controlled trial was conducted in the adult intensive care units ( ICUs ) of four general hospitals in Brazil . The 75 patients , who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days , were r and omized to the methadone ( MG ) or control group ( CG ) . Within the first 24 hours after study enrollment , both groups received 80 % of the original dose of fentanyl , the MG received enteral methadone and the CG received an enteral placebo . After the first 24 hours , the MG received an intravenous ( IV ) saline solution ( placebo ) , while the CG received IV fentanyl . For both groups , the IV solution was reduced by 20 % every 24 hours . The groups were compared by evaluating the MV weaning time and the duration of MV , as well as the ICU stay and the hospital stay . Results Of the 75 patients r and omized , seven were excluded and 68 were analyzed : 37 from the MG and 31 from the CG . There was a higher probability of early extubation in the MG , but the difference was not significant ( hazard ratio : 1.52 ( 95 % confidence interval ( CI ) 0.87 to 2.64 ; P = 0.11 ) . The probability of successful weaning by the fifth day was significantly higher in the MG ( hazard ratio : 2.64 ( 95 % CI : 1.22 to 5.69 ; P < 0.02 ) . Among the 54 patients who were successfully weaned ( 29 from the MG and 25 from the CG ) , the MV weaning time was significantly lower in the MG ( hazard ratio : 2.06 ; 95 % CI 1.17 to 3.63 ; P < 0.004 ) . Conclusions The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients result ed in a decrease in the weaning time from MV Introduction Reduction of automatic pressure support based on a target respiratory frequency or m and atory rate ventilation ( MRV ) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit ( ICU ) setting . We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients . Methods There were 106 patients selected in the post-operative period in a prospect i ve , r and omised , controlled protocol . When the patients arrived at the ICU after surgery , they were r and omly assigned to either : traditional weaning , consisting of the manual reduction of pressure support every 30 minutes , keeping the respiratory rate/tidal volume ( RR/TV ) below 80 L until 5 to 7 cmH2O of pressure support ventilation ( PSV ) ; or automatic weaning , referring to MRV set with a respiratory frequency target of 15 breaths per minute ( the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles , if the patient 's RR was less than 15 per minute ) . The primary endpoint of the study was the duration of the weaning process . Secondary endpoints were levels of pressure support , RR , TV ( mL ) , RR/TV , positive end expiratory pressure levels , FiO2 and SpO2 required during the weaning process , the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation . Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender ( p = 0.541 ) , age ( p = 0.585 ) and type of surgery ( p = 0.172 ) . Nineteen patients presented complications during the trial ( 4 in the PSV manual group and 15 in the MRV automatic group , p < 0.05 ) . Nine patients in the automatic group did not adapt to the MRV mode . The mean ± sd ( st and ard deviation ) duration of the weaning process was 221 ± 192 for the manual group , and 271 ± 369 minutes for the automatic group ( p = 0.375 ) . PSV levels were significantly higher in MRV compared with that of the PSV manual reduction ( p < 0.05 ) . Reintubation was not required in either group . Non-invasive ventilation was necessary for two patients , in the manual group after cardiac surgery ( p = 0.51 ) . Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU , but presented more complications , especially no adaptation to the MRV algorithm . Trial Registration Trial registration number : IS RCT Purpose Duration of weaning from mechanical ventilation  is decreased with the use of written protocol s in adults . In children , the use of written protocol s has not had such an impact . Methods and measurements We conducted a single-center trial to assess the feasibility of conducting a multicenter r and omized clinical trial comparing the duration of weaning from mechanical ventilation  in those managed by a computer-driven explicit protocol versus usual care .  Mechanically ventilated children aged between 2 and 17 years on pressure support and not receiving inotropes were included . After r and omization , children were weaned either by usual care ( n = 15 ) that was characterized by no protocol ized decisions by attending physicians , or by a computer-driven protocol ( Smartcare/PS ™ , Drager Medical ) ( n = 15 ) . Weaning duration until first extubation was the primary outcome . For comparison , a Mann – Whitney U test was employed ( p < 0.05 ) . Results Patients characteristics at inclusion were similar . The median duration of weaning was 21 h ( range 3–142 h ) in the SmartCare/PS ™ group and 90 h ( range 4–552 h ) in the usual care group , p = 0.007 . The rate of reintubation within 48 h after extubation and the rate of noninvasive ventilation after extubation in the SmartCare/PS ™ and usual care groups were 2/15 versus 1/15 and 2/15 versus 2/15 , respectively . Conclusions A pediatric r and omized trial on mechanical ventilation with a computerized protocol in North America is feasible . A computer-driven protocol that also manages children younger than 2 years old would help to decrease the number of PICU admissions screened in a multicentre trial on this topic Adaptive support ventilation ( ASV ) provides an automatic adaptation of the ventilator setting s to patient ’s passive and active respiratory mechanics . In a r and omized controlled study , we evaluated automatic respiratory weaning in ASV for early tracheal extubation after cardiac surgery . Eligible patients were assigned to either an ASV protocol or a st and ard one consisting of synchronized intermittent ventilation followed by pressure support .  Eighteen patients completed the ASV protocol , and 16 completed the st and ard one . There were no differences between groups in perioperative characteristics , lengths of tracheal intubation and intensive care unit stay , and ventilatory variables , except less peak inspiratory pressure during the initial phase in ASV ( 17.5 ± 0.8 versus 22.2 ± 0.8 cm H2O ; P < 0.01 ) . ASV patients required fewer ventilatory setting s manipulations ( 2.4 ± 0.7 versus 4.0 ± 0.8 manipulations per patient ; P < 0.05 ) and endured less high-inspiratory pressure alarms ( 0.7 ±  
    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: Purpose Weaning from prolonged mechanical ventilation may be associated with mental discomfort . It is not known whether such discomfort is linked with the development of post-traumatic stress disorder ( PTSD ) . Accordingly , we investigated whether PTSD occurs in patients after weaning from prolonged ventilation .  We also determined whether administering a question naire would identify patients at risk for developing PTSD . Methods A prospect i ve longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation  was undertaken : 72 patients were studied 1 week after weaning , and 41 patients were studied again 3 months later . An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD . To assess for the presence of PTSD-related symptoms , the post-traumatic stress syndrome ( PTSS-10 ) question naire was administered 1 week after weaning and 3 months later . Results The psychologist diagnosed PTSD in 12 % of patients 3 months after ventilator weaning . Patients who developed PTSD were more likely to have a previous history of psychiatric disorders ( P < 0.02 ) . A PTSS-10 score > 20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later : sensitivity 1.0 ; specificity 0.76 ; area under the receiver-operating characteristic curve 0.91 . Conclusion PTSD was diagnosed in 12 % of patients who were weaned from prolonged ventilation . A PTSS-10 score > 20 one week after weaning identified patients diagnosed with PTSD 3 months later . This finding suggests that a simple question naire administered before hospital discharge can identify patients at risk for developing PTSD Objectives It is not known if proportional assist ventilation with load-adjustable gain factors ( PAV+ ) may be used as a mode of support in critically ill patients . The aim of this study was to examine the effectiveness of sustained use of PAV+ in critically ill patients and compare it with pressure support ventilation ( PS ) . Design and setting R and omized study in the intensive care unit of a university hospital . Methods A total of 208 critically ill patients mechanically ventilated on controlled modes for at least 36 h and meeting certain criteria were r and omized to receive either PS  ( n = 100 ) or  PAV+ ( n = 108 ) . Specific written algorithms were used to adjust the ventilator setting s in each mode . PAV+ or PS was continued for 48 h unless the patients met pre-defined criteria either for switching to controlled modes ( failure criteria ) or for breathing without ventilator assistance . Results Failure rate was significantly lower in PAV+ than that in PS ( 11.1 vs. 22.0 % , P = 0.040 , OR 0.443 , 95 % CI 0.206–0.952 ) . The proportion of patients exhibiting major patient – ventilator dyssynchronies at least during one occasion and after adjusting the initial ventilator setting s , was significantly lower in PAV+ than in PS ( 5.6 vs. 29.0 % , P < 0.001 , OR 0.1 , 95 % CI 0.06–0.4 ) . The proportion of patients meeting criteria for unassisted breathing did not differ between modes . Conclusions PAV+ may be used as a useful mode of support in critically ill patients . Compared to PS , PAV+ increases the probability of remaining on spontaneous breathing , while it considerably reduces the incidence of patient – ventilator asynchronies Purpose IntelliVent-ASV ® is a development of adaptive support ventilation ( ASV ) that automatically adjusts ventilation and oxygenation parameters . This study assessed the safety and efficacy of IntelliVent-ASV ® in se date d intensive care unit ( ICU ) patients with acute respiratory failure . Methods This prospect i ve r and omized crossover comparative study was conducted in a 12-bed ICU in a general hospital . Two periods of 2 h of ventilation in r and omly applied ASV or IntelliVent-ASV ® were compared in 50 se date d , passively ventilated patients . Tidal volume ( VT ) , respiratory rate ( RR ) , inspiratory pressure ( PINSP ) , SpO2 and ETCO2 were continuously monitored and recorded breath by breath . Mean values over the 2-h period were calculated . Respiratory mechanics , plateau pressure ( PPLAT ) and blood gas exchanges were measured at the end of each period . Results There was no safety issue requiring premature interruption of IntelliVent-ASV ® . Minute ventilation ( MV ) and VT decreased from 7.6 ( 6.5–9.5 ) to 6.8 ( 6.0–8.0 ) L/min ( p < 0.001 ) and from 8.3 ( 7.8–9.0 ) to 8.1 ( 7.7–8.6 ) mL/kg PBW ( p = 0.003 ) during IntelliVent-ASV ® as compared to ASV . PPLAT and FiO2 decreased from 24 ( 20–29 ) to 20 ( 19–25 ) cmH2O ( p = 0.005 ) and from 40 ( 30–50 ) to 30 ( 30–39 ) % ( p < 0.001 ) during IntelliVent-ASV ® as compared to ASV . RR , PINSP , and PEEP decreased as well during IntelliVent-ASV ® as compared to ASV . Respiratory mechanics , pH , PaO2 and PaO2/FiO2 ratio were not different but PaCO2 was slightly higher during IntelliVent-ASV ® as compared to ASV . Conclusions In passive patients with acute respiratory failure , IntelliVent-ASV ® was safe and able to ventilate patients with less pressure , volume and FiO2 while producing the same results in terms of oxygenation Introduction Patients undergoing mechanical ventilation ( MV ) are frequently administered prolonged and /or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV . We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV . Methods A double-blind r and omized controlled trial was conducted in the adult intensive care units ( ICUs ) of four general hospitals in Brazil . The 75 patients , who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days , were r and omized to the methadone ( MG ) or control group ( CG ) . Within the first 24 hours after study enrollment , both groups received 80 % of the original dose of fentanyl , the MG received enteral methadone and the CG received an enteral placebo . After the first 24 hours , the MG received an intravenous ( IV ) saline solution ( placebo ) , while the CG received IV fentanyl . For both groups , the IV solution was reduced by 20 % every 24 hours . The groups were compared by evaluating the MV weaning time and the duration of MV , as well as the ICU stay and the hospital stay . Results Of the 75 patients r and omized , seven were excluded and 68 were analyzed : 37 from the MG and 31 from the CG . There was a higher probability of early extubation in the MG , but the difference was not significant ( hazard ratio : 1.52 ( 95 % confidence interval ( CI ) 0.87 to 2.64 ; P = 0.11 ) . The probability of successful weaning by the fifth day was significantly higher in the MG ( hazard ratio : 2.64 ( 95 % CI : 1.22 to 5.69 ; P < 0.02 ) . Among the 54 patients who were successfully weaned ( 29 from the MG and 25 from the CG ) , the MV weaning time was significantly lower in the MG ( hazard ratio : 2.06 ; 95 % CI 1.17 to 3.63 ; P < 0.004 ) . Conclusions The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients result ed in a decrease in the weaning time from MV Introduction Reduction of automatic pressure support based on a target respiratory frequency or m and atory rate ventilation ( MRV ) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit ( ICU ) setting . We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients . Methods There were 106 patients selected in the post-operative period in a prospect i ve , r and omised , controlled protocol . When the patients arrived at the ICU after surgery , they were r and omly assigned to either : traditional weaning , consisting of the manual reduction of pressure support every 30 minutes , keeping the respiratory rate/tidal volume ( RR/TV ) below 80 L until 5 to 7 cmH2O of pressure support ventilation ( PSV ) ; or automatic weaning , referring to MRV set with a respiratory frequency target of 15 breaths per minute ( the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles , if the patient 's RR was less than 15 per minute ) . The primary endpoint of the study was the duration of the weaning process . Secondary endpoints were levels of pressure support , RR , TV ( mL ) , RR/TV , positive end expiratory pressure levels , FiO2 and SpO2 required during the weaning process , the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation . Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender ( p = 0.541 ) , age ( p = 0.585 ) and type of surgery ( p = 0.172 ) . Nineteen patients presented complications during the trial ( 4 in the PSV manual group and 15 in the MRV automatic group , p < 0.05 ) . Nine patients in the automatic group did not adapt to the MRV mode . The mean ± sd ( st and ard deviation ) duration of the weaning process was 221 ± 192 for the manual group , and 271 ± 369 minutes for the automatic group ( p = 0.375 ) . PSV levels were significantly higher in MRV compared with that of the PSV manual reduction ( p < 0.05 ) . Reintubation was not required in either group . Non-invasive ventilation was necessary for two patients , in the manual group after cardiac surgery ( p = 0.51 ) . Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU , but presented more complications , especially no adaptation to the MRV algorithm . Trial Registration Trial registration number : IS RCT Purpose Duration of weaning from mechanical ventilation  is decreased with the use of written protocol s in adults . In children , the use of written protocol s has not had such an impact . Methods and measurements We conducted a single-center trial to assess the feasibility of conducting a multicenter r and omized clinical trial comparing the duration of weaning from mechanical ventilation  in those managed by a computer-driven explicit protocol versus usual care .  Mechanically ventilated children aged between 2 and 17 years on pressure support and not receiving inotropes were included . After r and omization , children were weaned either by usual care ( n = 15 ) that was characterized by no protocol ized decisions by attending physicians , or by a computer-driven protocol ( Smartcare/PS ™ , Drager Medical ) ( n = 15 ) . Weaning duration until first extubation was the primary outcome . For comparison , a Mann – Whitney U test was employed ( p < 0.05 ) . Results Patients characteristics at inclusion were similar . The median duration of weaning was 21 h ( range 3–142 h ) in the SmartCare/PS ™ group and 90 h ( range 4–552 h ) in the usual care group , p = 0.007 . The rate of reintubation within 48 h after extubation and the rate of noninvasive ventilation after extubation in the SmartCare/PS ™ and usual care groups were 2/15 versus 1/15 and 2/15 versus 2/15 , respectively . Conclusions A pediatric r and omized trial on mechanical ventilation with a computerized protocol in North America is feasible . A computer-driven protocol that also manages children younger than 2 years old would help to decrease the number of PICU admissions screened in a multicentre trial on this topic Adaptive support ventilation ( ASV ) provides an automatic adaptation of the ventilator setting s to patient ’s passive and active respiratory mechanics . In a r and omized controlled study , we evaluated automatic respiratory weaning in ASV for early tracheal extubation after cardiac surgery . Eligible patients were assigned to either an ASV protocol or a st and ard one consisting of synchronized intermittent ventilation followed by pressure support .  Eighteen patients completed the ASV protocol , and 16 completed the st and ard one . There were no differences between groups in perioperative characteristics , lengths of tracheal intubation and intensive care unit stay , and ventilatory variables , except less peak inspiratory pressure during the initial phase in ASV ( 17.5 ± 0.8 versus 22.2 ± 0.8 cm H2O ; P < 0.01 ) . ASV patients required fewer ventilatory setting s manipulations ( 2.4 ± 0.7 versus 4.0 ± 0.8 manipulations per patient ; P < 0.05 ) and endured less high-inspiratory pressure alarms ( 0.7 ±  
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