CHEST Guidelines-Limitations-on-PassItOn-Design-and-Execution-Shoul

Limitations-on-PassItOn-Design-and-Execution-Shoul

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The document includes correspondence and discussions from two medical studies published in the journal CHEST.<br /><br />The first segment discusses findings from the VESPA trial related to ventilatory strategies during bronchoscopy under general anesthesia. The trial emphasizes the benefits of using an endotracheal tube over a laryngeal mask airway (LMA) in the VESPA strategy. The authors note that while positive end-expiratory pressure (PEEP) can be delivered safely through an LMA, the recruitment maneuver associated with the VESPA strategy involves high pressures that are not deemed safe for an LMA. The endotracheal tube facilitates these pressures and is compatible with robotic peripheral bronchoscopies. Further studies are recommended for evaluating LMA use under modified conditions without recruitment maneuvers.<br /><br />The second segment critiques the methodology and outcome of the PassItOn trial, which evaluated the efficacy of COVID-19 convalescent plasma (CCP) in hospitalized patients. The authors argue that the trial’s design and execution introduced biases, particularly due to inclusion of patients with late-stage disease less likely to benefit from CCP, as well as some patients not receiving effective doses of neutralizing antibodies. They suggest that early administration of CCP is effective, but the trial's late intervention obscured its potential efficacy.<br /><br />Overall, both segments discuss the importance of methodological considerations in clinical trials, with suggestions for further research and improved experimental designs to accurately determine the benefits of medical interventions.

Keywords

VESPA trial

ventilatory strategies

bronchoscopy

endotracheal tube

laryngeal mask airway

PEEP

recruitment maneuver

PassItOn trial

COVID-19 convalescent plasma

clinical trials