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Mechanical ventilation for patients with lung damage don't always work as planned
Date:11/12/2009

TORONTO, Ont., November 12, 2009 As more Canadians are diagnosed with H1N1 influenza infection, some will be admitted to hospital. The most severely affected may be treated in the intensive care unit (ICU) and placed on a mechanical ventilator to help them breathe while they recover from the infection.

While mechanical ventilation clearly saves the lives of many people felled by serious illness, in some cases, this supportive measure has been known to damage the lungs, says Dr. Arthur S. Slutsky, a scientist at St. Michael's Hospital in Toronto.

"In clinicians' previous zeal to maintain relatively normal blood gas values, they have ventilated patients using relatively large tidal volumes," Dr. Slutsky explains. "They also tended to ventilate patients in the supine positionthat is, while they lay on their backs."

("Tidal volume" refers to the normal volume of air displaced in the lungs between normal inhalation and exhalation when extra effort is not applied. Other studies have found that lowering tidal volumes decreases mortality rates in ventilated patients.)

"Ventilation is what we call a physiological-based treatment," he explains. "We look at the patient's current physiological state, then devise and use treatments aimed at altering this state, hoping the change will translate into recovery."

In the case of severe H1N1 infection of the lungs, patients can develop severe hypoxemiaan abnormally low amount of oxygen in the arterial blood which is the major result of respiratory failure.

In an editorial published this week in the Journal of the American Medical Association (JAMA), Dr. Slutsky comments on new research published by Fabio S. Taccone and colleagues from the University of Milan in Milan, Italy.

The researchers looked at whether patients with Acute Respiratory Distress Syndrome (ARDS) who were mechanically ventilated in the prone position (lying on their stomachs) did be
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Contact: Julie Saccone
sacconej@smh.toronto.on.ca
416-864-5047
St. Michael's Hospital
Source:Eurekalert

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