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Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. Methods: PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two diffe…

ROHHAD syndrome

ROHHAD is a clinical entity with a median age of 3 years at onset characterised by sudden onset of dramatic weight gain, dysautonomia, and pulmonary complications. These include alveolar hypoventilation, obstructive sleep apnoea, and decreased central responsiveness to carbon dioxide concentrations. There are also several endocrinopathies associated with this disorder including hypernatraemia, hyperprolactinemia, hypothyroidism, and diabetes insipidus. Additional features of the disease include behavioural and mood disorders, as well as seizures and learning impairment. There is an associated entity known as ROHHADNET with a predisposition towards the development of neuroectodermal tumours.…

Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated b…

Correction to: Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): Study protocol for a randomized controlled trial (Trials (2019) 20: 213 DOI: 10.1186/s13063-019-3208-8)

After publication of the original article [1], the authors have notified us that two of the collaborator first and last names have been inverted in the "PROTHOR Investigators" table. The correct information is: Surname: Spadaro Name: Savino Surname Vitali Name Costanza The original article has been corrected.

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Medical communications and writing for patients

In this first edition of 2021’s Medical Writing, I am delighted to present a piece from Filippo Vitale and colleagues. This is a truly fascinating article that discusses how we have communicated science and scientific facts throughout history and how changes in societyhave affected how this is done and the outcomes that this has produced. I found this article extremely thought- provoking (and at times a sad reflection of where we have come to as a global society) as the authors document and explain concepts like “clickbait” and “fake news”. Whilst it was truly educational to understand the evolution of these concepts, I totally echo the authors’ call to arms in their plea for us to be more …

Tracheostomy, swallowing disorders and rehabilitation: it is never too late.