This study was consistent with a recent publication showing that the administration of PJ-34 attenuated VILI in a rat model in which two-hit injury was induced by intratracheal lipopolysaccharide instillation followed by mechanical ventilation [24]. Taken together, these studies suggest that pharmacological interventions SKLB1002? targeting specific inflammatory molecules may eventually have a role to play in the treatment of VILI.Tracheotomy decannulation and noninvasive ventilationTracheotomy is performed in approximately one-tenth of mechanically ventilated patients to facilitate prolonged airway management. The relatively new technique for percutaneous dilatational tracheotomy may result in tracheotomy becoming an even more common surgical procedure in the ICU.

The majority of tracheotomized patients who survive their illness can eventually be effectively decannulated. However, there is a lack of consensus as to when a tracheotomy tube should be removed. Stelfox and coworkers [25] conducted a cross-sectional survey of 225 responding clinicians involved in routine tracheotomy management at 118 medical centres. The patients’ levels of consciousness, ability to tolerate tracheotomy tube capping, cough effectiveness and secretions were rated as the most important factors in the decision to remove a tracheotomy tube from a patient. The survey indicated that patients were most likely to be recommended for decannulation if they were alert and interactive, had a strong cough, had scant thin secretions and required minimal supplemental oxygen.

Decannulation failure was defined as the need to re-establish an artificial airway within 48 to 96 hours of planned tracheotomy removal, which ranged between 2% and 5%.A number of complications may occur during invasive mechanical ventilation, such as complications of intubation, ventilator-associated pneumonia, VILI (barotrauma, volutrauma and biotrauma), cardiovascular effects and so on. Noninvasive positive-pressure mechanical ventilation (NPPV) has been investigated as an alternative in the management of patients with ALI. Trevisan and coworkers [26] addressed the question of whether NPPV would be beneficial in weaning patients from invasive mechanical ventilation. Of 65 patients who failed a spontaneous breathing T-piece trial during weaning, 28 were randomly assigned to NPPV and 37 were assigned to invasive mechanical ventilation.

The incidence of complications (pneumonia and tracheotomy) was lower in the NPPV group than in the invasive mechanical ventilation group. Although there was a tendency toward decreased ICU and hospital stays, the differences did not achieve statistical significance. The authors concluded that the combination of early extubation and NPPV is a useful and safe alternative for ventilation of patients who Brefeldin_A fail initial weaning attempts.