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Comments on the study by Taniguchi and coworkers – proving Hippocrates is alive

Critical Care
Springer (Biomed Central Ltd.)
Publication Date
DOI: 10.1186/cc7957
  • Letter
  • Computer Science


CC7957-Cakar.qxd Available online Page 1 of 2 (page number not for citation purposes) I read with interest the article by Taniguchi and coworkers [1] and its accompanying commentary by AdIgüzel and colleagues [2] in Critical Care. I have some questions concerning the methodology of the study. Taniguchi and coworkers randomized the postoperative patients to two groups: automated pressure support (PS) mandatory rate ventilation (MRV) and manual PS. In the automated PS MRV group, the patient’s expected respiratory rate (RR) was used as a guide to adjust the PS level, employing the algorithm of the Taema-Horus Ventilator® (Air Liquid, France) in MRV mode. However, in the manual PS group the guide for adjusting the PS level was tidal volume/RR (which was kept less than 80 l), and adjustments were done manually every 30 minutes by intensive care staff. The study did not compare automated weaning with manual weaning. Rather, it compared automated weaning using a RR target versus manual weaning using tidal a volume/RR ratio target. To justify the conclusions reached by Taniguchi and coworkers and the title of the report, these treatment groups would have needed to differ only in terms of the automated versus manual management component. Second, they weaned the patients when the PS level decreased to 5 to 7 cmH2O without conducting a spon- taneous breathing trial at the start of the study. This may complicate weaning and prolong the weaning time in this group of patients. Third, are postoperative patients suitable for such a weaning study? It is likely that whatever protocol you use for weaning, most of them will be weaned without any difficulty in a very short period of time. To prove that Hippocrates is alive we need fine-tuned studies. If not we may believe that he is alive but it will be unproven. Letter Comments on the study by Taniguchi and coworkers - proving Hippocrates is alive Nahit Cakar Istanbul Medical Faculty, Anesthesiology and In

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