Avances en la comprensión y el tratamiento de las enfermedades del hígado durante el embarazo: Una revisión.

Avances en la comprensión y el tratamiento de las enfermedades del hígado durante el embarazo: Una revisión. Advances in understanding and treating liver diseases during pregnancy: A review. Kamimura K, Abe H, Kawai H, Kamimura H, Kobayashi Y, Nomoto M, Aoyagi Y, Terai S. World J Gastroenterol. 2015 May 7;21(17):5183-90. doi: 10.3748/wjg.v21.i17.5183. Abstract Liver disease in pregnancy is rare but pregnancy-related liver diseases may cause threat to fetal and maternal survival. It includes pre-eclampsia;eclampsia; haemolysis, elevated liver enzymes, and low platelets syndrome; acute fatty liver of pregnancy; hyperemesis gravidarum; and intrahepatic cholestasis of pregnancy. Recent basic researches have shown the various etiologies involved in this disease entity. With these advances, rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival. The other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic intervention. Therefore, correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better prognosis. Therefore, here we review and summarized recent advances in understanding the etiologies, clinical courses and management of liver disease in pregnancy. This information will contribute to physicians for diagnosis of disease and optimum management of patients. KEYWORDS: Acute fatty liver of pregnancy; Haemolysis elevated liver enzymes; Hyperemesis gravidarum; Intrahepatic cholestasis of pregnancy; Liver injury; Low platelets; Pregnancy PDF Hepatopatías relacionadas al embarazo Pregnancy-related liver disorders. Goel A, Jamwal KD, Ramachandran A, Balasubramanian KA, Eapen CE. J Clin Exp Hepatol. 2014 Jun;4(2):151-62. doi: 10.1016/j.jceh.2013.03.220. Epub 2013 Mar 16. Abstract Pregnancy-related liver disorders accounted for 8% of all maternal deaths at our center from 1999 to 2011. Of the three pregnancy-related liver disorders (acute fatty liver of pregnancy (AFLP), HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclamptic liver dysfunction, which can lead to adverse maternal and fetal outcome, AFLP is most typically under - diagnosed. Risk of maternal death can be minimised by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these life threatening disorders, but recent advancements in our understanding help us in better overall management of these patients. This review focuses on various aspects of pregnancy-related liver disorders. PDF

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Dra. Virginia Apgar una vida ejemplar

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 29 de Julio 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Dra. Virginia Apgar una vida ejemplar” por la “Dra. Rosaura Del Valle Avilez”, Pediatra de la Cd. de Tlaxcala. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/virginia_apgar/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”

5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

Desentrañando las teorías de la preeclampsia: son las vías de protección del nuevo paradigma?

Desentrañando las teorías de la preeclampsia: son las vías de protección del nuevo paradigma? Unravelling the theories of pre-eclampsia: are the protective pathways the new paradigm? Ahmed A, Ramma W. Br J Pharmacol. 2015 Mar;172(6):1574-86. doi: 10.1111/bph.12977. Abstract Pre-eclampsia is a vascular disorder of pregnancy where anti-angiogenic factors, systemic inflammation and oxidative stress predominate, but none can claim to cause pre-eclampsia. This review provides an alternative to the 'two-stage model' of pre-eclampsia in which abnormal spiral arteries modification leads to placental hypoxia, oxidative stress and aberrant maternal systemic inflammation. Very high maternal soluble fms-like tyrosine kinase-1 (sFlt-1 also known as sVEGFR) and very low placenta growth factor (PlGF) are unique to pre-eclampsia; however, abnormal spiral arteries and excessive inflammation are also prevalent in other placental disorders. Metaphorically speaking, pregnancy can be viewed as a car with an accelerator and brakes, where inflammation, oxidative stress and an imbalance in the angiogenic milieu act as the 'accelerator'. The 'braking system' includes the protective pathways of haem oxygenase 1 (also referred as Hmox1 or HO-1) and cystathionine-γ-lyase (also known as CSE or Cth), which generate carbon monoxide (CO) and hydrogen sulphide (H2S) respectively. The failure in these pathways (brakes) results in the pregnancy going out of control and the system crashing. Put simply, pre-eclampsia is an accelerator-brake defect disorder. CO and H2S hold great promise because of their unique ability to suppress the anti-angiogenic factors sFlt-1 and soluble endoglin as well as to promote PlGF and endothelial NOS activity. The key to finding a cure lies in the identification of cheap, safe and effective drugs that induce the braking system to keep the pregnancy vehicle on track past the finishing line.PDF

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TÉCNICAS ANESTÉSICAS EN CIRUGÍA DE MANO. Dra. Elizabeth Wing / Reunión Bianual 2015, Congreso de la Asociación Mexicana de Cirugía de la Mano AC

#amcmano2015
http://www.amcmano.org/congreso2015/
Inscríbete!!!
http://amcmano.org/congreso2015/registro/view/index.php

Buenos días estimados amigos en la red, nuevamente les recuerdo la Reunión Bianual 2015 que celebra el congreso de la Asociación Mexicana de Cirugía de la Mano AC, en esta ocasión se llevará a cabo en la ciudad de Cuernavaca Morelos, en el auditorio de la facultad de medicina de la UAEM, junto a la cruz roja, una zona muy segura de la ciudad, , la segunda platica que tendrmos en dicha reunión será:
TÉCNICAS ANESTÉSICAS EN CIRUGÍA DE MANO. Dra. Elizabeth Wing

ML supreme en resucitación neonatal. Estudio randomizado y controlado

ML supreme en resucitación neonatal. Estudio randomizado y controlado LMA Supreme for neonatal resuscitation: study protocol for a randomized controlled trial. Trevisanuto D, Cavallin F, Mardegan V, Loi NN, Tien NV, Linh TD, Chien TD, Doglioni N, Chiandetti L, Moccia L. Trials. 2014 Jul 15;15:285. doi: 10.1186/1745-6215-15-285. Abstract BACKGROUND: The most important action in the resuscitation of a newborn in the delivery room is to establish effective assisted ventilation. The face mask and endotracheal tube are the devices used to achieve this goal. Laryngeal mask airways that fit over the laryngeal inlet have been shown to be effective for ventilating newborns at birth and should be considered as an alternative to facemask ventilation or endotracheal intubation among newborns weighing >2,000 g or delivered ≥34 weeks' gestation. A recent systematic review and meta-analysis of supraglottic airways in neonatal resuscitation reported the results of four randomized controlled trials (RCTs) stating that fewer infants in the group using laryngeal maskairways required endotracheal intubation (1.5%) compared to the group using face masks (12.0%). However, there were methodological concerns over all the RCTs including the fact that the majority of the operators in the trials were anesthesiologists.Our hypothesis is based on the assumption that ventilating newborns needing positive pressure ventilation with a laryngeal mask airway will be more effective than ventilating with a face maskin a setting where neonatal resuscitation is performed by midwives, nurses, and pediatricians. The primary aim of this study will be to assess the effectiveness of the laryngeal mask airway over the face mask in preventing the need for endotracheal intubation. METHODS/DESIGN: This will be an open, prospective, randomized, single center, clinical trial. In this study, 142 newborns weighing >1,500 g or delivered ≥34 weeks gestation needing positive pressure ventilation at birth will be randomized to be ventilated with a laryngeal mask airway (LMA SupremeTM, LMA Company, UK - intervention group) or with a face mask (control group). PRIMARY OUTCOME: Proportion of newborns needing endotracheal intubation. SECONDARY OUTCOMES: Apgar score at 5 minutes, time to first breath, onset of the first cry, duration of resuscitation, death or moderate to severe hypoxic-ischemic encephalopathy within 7 days of life. PDF

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Embarazo patológico / Pathological pregnancy

La carga de la eclampsia: resultados de un estudio multicéntrico sobre la vigilancia de la morbilidad materna severa en Brasil. The burden of eclampsia: results from a multicenter study on surveillance of severe maternal morbidity in Brazil. Giordano JC, Parpinelli MA, Cecatti JG, Haddad SM, Costa ML, Surita FG, Pinto E Silva JL, Sousa MH. PLoS One. 2014 May 13;9(5):e97401. doi: 10.1371/journal.pone.0097401. eCollection 2014. Abstract OBJECTIVE: Maternal mortality (MM) is a core indicator of disparities in women's rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). METHODS: Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO's obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect). RESULTS: Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48-3.59) were associated with SMO. CONCLUSIONS: Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia. PDF Hipertensión crónica y evolución del embarazo. Revisión sistemática y meta-análisis Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. BMJ. 2014 Apr 15;348:g2301. doi: 10.1136/bmj.g2301. Abstract OBJECTIVE: To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. STUDY SELECTION: Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. DATA EXTRACTION: Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). RESULTS: 55 eligible studies were identified, encompassing 795,221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery <37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight <2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), andperinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ(2)=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery <37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight <2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. CONCLUSIONS: This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension. PDF Anticuerpos antifosfolípidos y síndrome antifosfolípido durante en embarazo. Conceptos de diagnóstico Antiphospholipid Antibodies and Antiphospholipid Syndrome during Pregnancy: Diagnostic Concepts. Levy RA, Dos Santos FC, de Jesús GR, de Jesús NR. Front Immunol. 2015 May 7;6:205. doi: 10.3389/fimmu.2015.00205. eCollection 2015. Abstract Antiphospholipid syndrome (APS) comprises of a wide spectrum of clinical and obstetric manifestations linked to the presence of antiphospholipid antibodies (aPL). APS was described in the context of lupus, and later as an isolated syndrome or primary APS. The presence of aPL, especially the lupus anticoagulant test, is associated with adverse pregnancy outcomes, such as fetal death, recurrent early miscarriages, pre-eclampsia, and placental insufficiency, but does not seem to influence infertility. High quality scientific data to support these associations, however, are lacking, and controversies arise about the definition of positive aPL (low vs medium-high titers) or even the definition of the adverse events. This reviewdiscusses APS classification criteria and the current debate about it. KEYWORDS: antiphospholipid antibodies; antiphospholipid syndrome; fetal death; recurrent early miscarriage PDF

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Paracetamol. Revisión enfocada en los efectos hemodinámicos de la administración intravenosa

Paracetamol. Revisión enfocada en los efectos hemodinámicos de la administración intravenosa Paracetamol: a review with specific focus on the haemodynamic effects of intravenous administration. Chiam E, Weinberg L, Bellomo R. Heart Lung Vessel. 2015;7(2):121-32. Abstract Paracetamol is one of the most commonly used drugs worldwide with non-prescription sales exceeding 25 thousand million doses per year in the United States of America. The haemodynamic effects of the intravenous paracetamol formulations are largely understudied. There is an emerging body of evidence suggesting that intravenous paracetamol may cause iatrogenic hypotension. Little is known as to the mechanisms of this phenomenon or if intravenous paracetamol indeed does cause hypotension. As paracetamol has negligible solubility in aqueous solutions, many of the commercially available intravenous formulations contain mannitol (up to 3.91 g/100 mL paracetamol) as a stabilising ingredient. It is unknown if mannitol is a contributing factor in the observed hypotension. In this review, we outline the development of paracetamol's current intravenous formulations, describe the composition of these formulations, and overview the literature pertaining to the proposed phenomenon of paracetamol-induced altered hypotension. Understanding the pharmacokinetic and pharmacodymanic properties of intravenous paracetamol may have important clinical implications for vulnerable patients in subgroups where haemodynamic stability is at risk such as those undergoing elective and emergency surgery. KEYWORDS: Intravenous; acetaminophen; blood pressure; haemodynamic; paracetamol PDF

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Tramadol y eyaculación prematura / Tramadol and premature ejaculation

Tramadol para eyaculación prematura. Revisión sistemática y meta-análisis Tramadol for premature ejaculation: a systematic review and meta-analysis. Martyn-St James M, Cooper K, Kaltenthaler E, Dickinson K, Cantrell A, Wylie K, Frodsham L, Hood C. BMC Urol. 2015 Jan 30;15(1):6. [Epub ahead of print] Abstract BACKGROUND: Tramadol is a centrally acting analgesic prescribed off-label for the treatment of premature ejaculation (PE). However, tramadol may cause addiction and difficulty in breathing and the beneficial effect of tramadol in PE is yet not supported by a high level of evidence. The purpose of this study was to systematically review the evidence from randomised controlled trials (RCT) for tramadol in the management of PE. METHODS: We searched bibliographic databases including MEDLINE to August 2014 for RCTs. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. Between-group differences in IELT and other outcomes were pooled across RCTs in a meta-analysis. Statistical and clinical between-trial heterogeneity was assessed. RESULTS: A total of eight RCTs that evaluated tramadol against a comparator were included. The majority of RCTs were of unclear methodological quality due to limited reporting. Pooled evidence (four RCTs, 721 participants), suggests that tramadol is significantly more effective than placebo at increasing IELT over eight to 12 weeks (p = 0.0007). However, a high level of statistical heterogeneity is evident (I-squared = 74%). Single RCT evidence indicates that tramadol is significantly more effective than paroxetine taken on-demand, sildenafil, lidocaine gel, or behavioural therapy on IELT in men with PE. Tramadol is associated with significantly more adverse events including: erectile dysfunction, constipation, nausea, headache, somnolence, dry mouth, dizziness, pruritus, and vomiting, than placebo or behavioural therapy over eight to 12 weeks of treatment. However, addiction problems or breathing difficulties reported by patients for PE is not assessed in the current evidence base. CONCLUSIONS: Tramadol appears effective in the treatment of PE. However, these findings should be interpreted with caution given the observed levels of between-trial heterogeneity and the reporting quality of the available evidence. The variability across placebo-controlled trials in terms of the tramadol dose evaluated and the treatment duration does not permit any assessment of a safe and effective minimum daily dose. The long-term effects and side effects, including addiction potential, for men with PE have not been evaluated in the current evidence base PDF Estudio aletorizado, doble ciego, controlado con placebo, cruzado de tramadol a demanda para manejo de eyaculación prematura A randomized, double-blind, placebo-controlled, crossover trial of "on-demand" tramadol for treatment of premature ejaculation. Kurkar A, Elderwy AA, Abulsorour S, Awad SM, Safwat AS, Altaher A. Urol Ann. 2015 Apr-Jun;7(2):205-10. doi: 10.4103/0974-7796.150481. Abstract OBJECTIVES: The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation (PE). SUBJECTS AND METHODS: During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported. RESULTS: Of patients enrolled, 125 (69.4%) continued the study. Patients' age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg (P < 0.001 for all comparisons). PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively (P < 0.001 for all comparisons). On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol50 mg (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001) and tramadol 100 mg (OR: 1.07, 95% CI: 1.04-1.11, P < 0.001). Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol (P < 0.001). Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively (P = 0.002). Two patients discontinued tramadol 100 mg due to side-effects. CONCLUSION: Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE. KEYWORDS: Intra-vaginal ejaculatory latency time; premature ejaculation; tramadol hydrochloride PDF

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Ventilación mecánica / Mechanical ventilation

Ventilación mecánica en el síndrome de falla respiratoria aguda Mechanical ventilation of acute respiratory distress syndrome. Ochiai R. J Intensive Care. 2015 May 29;3(1):25. doi: 10.1186/s40560-015-0091-6. eCollection 2015. Abstract Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure. There is so much controversy regarding what the best PEEP is, whether collapsed lung should be recruited, and what parameters should be measured and evaluated to improve the outcome of ARDS. Since the mechanical ventilation for patients with respiratory failure, including ARDS, is a standard care, we need more dynamic and regional information of ventilation and pulmonary circulation in the injured lungs to evaluate the efficacy of new type of treatment strategy. In addition to the CT scanning of the lung as the gold standard of evaluation, the electrical impedance tomography (EIT) of the lung has been clinically available to provide such information non-invasively and at the bedside. Various parameters have been tested to evaluate the homogeneity of regional ventilation, and EIT could provide us with the information of ventilator settings to minimize VILI. KEYWORDS: Acute respiratory distress syndrome; Baby lung; Electrical impedance tomography; Gravitational effect; Lung protective strategy; Prone positioning; Ventilator-induced lung injury PDF PReVENT- ventilación protectiva en pacientes sin ARDS al iniciar la ventilación. Protocolo de estudio para una investigación controlada randomizada PReVENT - protective ventilation in patients without ARDS at start of ventilation: study protocol for a randomized controlled trial. Simonis FD, Binnekade JM, Braber A, Gelissen HP, Heidt J, Horn J, Innemee G, de Jonge E, Juffermans NP, Spronk PE, Steuten LM, Tuinman PR, Vriends M, de Vreede G, de Wilde RB, Serpa Neto A, Gama de Abreu M, Pelosi P, Schultz MJ. Trials. 2015 May 24;16:226. doi: 10.1186/s13063-015-0759-1. Abstract BACKGROUND: It is uncertain whether lung-protective mechanical ventilation using low tidal volumes should be used in all critically ill patients, irrespective of the presence of the acute respiratory distress syndrome (ARDS). A low tidal volume strategy includes use of higher respiratory rates, which could be associated with increased sedation needs, a higher incidence of delirium, and an increased risk of patient-ventilator asynchrony and ICU-acquired weakness. Another alleged side-effect of low tidal volume ventilation is the risk of atelectasis. All of these could offset the beneficial effects of low tidal volume ventilation as found in patients with ARDS. METHODS/DESIGN: PReVENT is a national multicenter randomized controlled trial in invasively ventilated ICU patients without ARDS with an anticipated duration of ventilation of longer than 24 hours in 5 ICUs in The Netherlands. Consecutive patients are randomly assigned to a low tidal volume strategy using tidal volumes from 4 to 6 ml/kg predicted body weight (PBW) or a high tidal volume ventilation strategy using tidal volumes from 8 to 10 ml/kg PBW. The primary endpoint is the number of ventilator-free days and alive at day 28. Secondary endpoints include ICU and hospital length of stay (LOS), ICU and hospital mortality, the incidence of pulmonary complications, including ARDS, pneumonia, atelectasis, and pneumothorax, the cumulative use and duration of sedatives and neuromuscular blocking agents, incidence of ICU delirium, and the need for decreasing of instrumental dead space. DISCUSSION: PReVENT is the first randomized controlled trial comparing a low tidal volume strategy with a high tidal volume strategy, in patients without ARDS at onset of ventilation, that recruits a sufficient number of patients to test the hypothesis that a low tidal volume strategy benefits patients without ARDS with regard to a clinically relevant endpoint. TRIAL REGISTRATION: The trial is registered at www.clinicaltrials.gov under reference number NCT02153294 on 23 May 2014. PDF

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