Materials and methodsThree hundred and thirty-one patients who were kinase inhibitor Enzalutamide on mechanical ventilation for more than 24 hours were evaluated. Patients younger than 18 years of age or with neurological and neuromuscular diseases were excluded from the study. The study was conducted from September 2004 to January 2008 in three general intensive care units (ICUs) of the Hospital de Cl��nicas de Niter��i (Rio de Janeiro – Brazil), totaling 27 beds. It was approved by the ethics committees of our institution and registered as an International Standard Randomized Controlled Trial under number 92117906. Informed consent was obtained from each patient, whenever possible, or from the patient’s next of kin. The ventilators used were Evita 2 (Dr?ger, L��beck, Germany).
Discontinuation from mechanical ventilation was attempted when the physician in charge judged that the patient was ready to be weaned, according to the following criteria: the cause for starting mechanical ventilation had resolved or at least improved; body temperature was below 38.5��C; hemoglobin was equal to or higher than 8 g/dl; and none or a minimal dose of vasoactive or sedative drugs was administered. A PaO2 of 60 mm Hg or more or SaO2 of 90% or more with a FiO2 of 0.4 or less and positive end-expiratory pressure (PEEP) of 8 cmH2O or less were other criteria to be met. A SBT was then evaluated by means of a 2-hour T-piece.The static compliance of the respiratory system (Cst,rs) was measured in volume control ventilation through the same method used by Aboussouan and colleagues [12], after assessing the digital display of the ventilator to verify the pressure-time curve without inspiratory efforts of the patients.
An inspiratory hold for 0.5 to 1.0 second was used to measure the compliance. Cst,rs was calculated by dividing the Vt by the difference between inspiratory plateau pressure and PEEP. A bedside spirometer (Ohmeda RM 121, Tokyo, Japan) was attached to the expiratory valve of the ventilator in order to check the Cilengitide Vt measurement before each calculation of Cst,rs.Before the weaning trial, all patients were being ventilated in pressure support ventilation 8 to 10 cmH2O and PEEP 5 cmH2O. To measure tracheal airway occlusion pressure (P 0.1), pressure support was reduced to 7 cmH2O and the P 0.1 value was obtained from the average of three consecutive measurements with intervals of 15 seconds [13,14]. A sample of arterial blood to analyze the SaO2 and the PaO2/FiO2 ratio was collected in pressure support 7 cmH2O, PEEP 5 cmH2O and FiO2 0.35.During the first minute after discontinuation from mechanical ventilation, spontaneous minute volume and respiratory rate were measured with a bedside spirometer (Ohmeda RM 121, Tokyo, Japan) attached to the airway.
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