Despite a plethora of publications on the art and science of respiratory care, a number of basic issues remain unanswered. These clinical controversies are often settled by expert opinion and personal bias. By definition, a controversy has compelling arguments for each side of the issue. This Respiratory Care Journal Conference addressed 12 clinical controversies, ranging from spirometry screening for chronic lung disease to the timing of tracheostomy. This paper is a concise synopsis of the salient points of each side of each argument and provides the points of consensus and points of contention. When appropriate, further research is suggested to address still unanswered questions.
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MacIntyreNR, SeleckyPA. Is there a role for screening spirometry?. Respir Care, 2010; 55(1):35:40; discussion 40-42.
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SesslerCN, GayPC. Are corticosteroids useful in late-stage acute respiratory distress syndrome?. Respir Care, 2010; 55(1):43–52; discussion 53-55.
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SteinbergKP, HudsonLD, GoodmanRB, HoughCL, LankenPN, HyzyR, et al; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 20354(16):1671–1684.
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KingCS, MooresLK, EpsteinSK. Should patients be able to follow commands prior to extubation?. Respir Care, 2010; 55(1):56–62; discussion 62-65.
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GayPC, SeleckyPA. Are sleep studies appropriately done in the home?. Respir Care, 2010; 55(1):63–73; discussion 73-75.
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MulgrewAT, FoxN, NajibTA, RyanCF. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med, 2007; 146(3):157–166.
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DurbinCG, PerkinsMP, MooresLK. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation?. Respir Care, 2010; 55(1):76–83; discussion 83-87.
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FesslerHE, TalmorDS. Should prone positioning be routinely used for lung protection during mechanical ventilation?. Respir Care, 2010; 55(1):88–96; discussion 96-99.
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SudS, SudM, FriedrichJO, AdhikariNK. Effect of mechanical ventilation in the prone position on clinical outcomes in patient with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ, 2008; 178(9):1153–1161.
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SiobalMS, HessDR. Are inhaled vasodilators useful in acute lung injury and acute respiratory distress syndrome?. Respir Care, 2010; 55(2):144–157; discussion 157-161.
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AdhikariNK, BurnsKE, FriedrichJO, GrantonJT, CookDJ, MeadeMO. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007; 334(7597):769–779.
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TalmorDS, FesslerHE. Are esophageal pressure measurements important in clinical decision-making in mechanically ventilated patients?. Respir Care, 2010; 55(2)162–172; discussion 172-174.
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TalmorD, SargeT, MalhotraA, O'DonnellCR, RitzR, LisbonA, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med, 2008; 359(20):2095–2104.
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MacIntyreNR, SesslerCN. Are there benefits or harm from pressure targeting during lung-protective ventilation?. Respir Care, 2010; 55(2):175–180; discussion 180-183.
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KalletRH, CampbellAR, DickerRA, KatzJA, MackersieRC. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respir Care, 2005; 50(12):1623–1631.
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HagerDN, KrishnanJA, HaydenDL, BrowerRG. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med, 2005; 172(10):1241–1245.
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GentileMA, SiobalMS. Are specialized endotracheal tubes and heat moisture exchangers cost-effective in preventing ventilator associated pneumonia?. Respir Care, 2010; 55(2):184–196; discussion 196-197.
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EpsteinSK, DurbinCGJr. Should a patient be extubated and placed on noninvasive ventilation after failing a spontaneous breathing trial?. Respir Care, 2010; 55(2):198–206; discussion 207-208.
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BransonRD, GentileMA. Is humidification always necessary during noninvasive ventilation in the hospital?. Respir Care, 2010; 55(2):209–216; discussion 216.
