During early acute respiratory failure, RMs increase oxygenation and lung volume, and may reduce lung edema [9,12]. Some authors have suggested that there is a potential benefit of an early RM after induction of anesthesia in the operating room [11]. To date, however, no study has evaluated kinase inhibitor Imatinib Mesylate the short-term effect of a RM performed early after intubation in critically ill patients.RMs can damage or transiently alter the integrity of the alveolar-capillary barrier and promote transient bacterial translocation in animal models [13,14]. However, these hypotheses remain unanswered in humans [15].Therefore, our aim was to determine whether a RM, performed immediately after intubation, was more effective compared with standard management strategies at reducing short-term hypoxemia in hypoxemic patients requiring intubation for invasive ventilation in the ICU.

We also aimed to evaluate some aspect of the safety of the procedure.Materials and methodsThe study design was approved by our local ethics committee (Comite de Protection des Personnes dans la Recherche Biomedicale), and written informed consent was obtained from each patient or the patient’s next of kin or legal representative. In emergency situations, delayed consent from patients or family was authorized. We generated a random-number table using a personal computer, and employed this table to prepare envelopes for random patient allocation. The envelopes were opaque, sealed, and numbered to ensure treatment concealment and sequential use. The envelopes were transferred one by one in the second ICU and thereafter opened when a patient was included.

Study populationAdult patients were recruited in two medicosurgical ICUs of the same French University hospital of Clermont-Ferrand and were considered eligible if they met two criteria: acute hypoxemic respiratory failure requiring intubation; and hypoxemia, defined as a partial pressure of arterial oxygen (PaO2) less than 100 mmHg under a high fraction of inspired oxygen (FiO2) mask driven by at least 10 L/min oxygen [8]. Encephalopathy or coma, a need for cardiac resuscitation, hyperkalemia of more than 5.5 mEq/L (contraindication to the succinylcholine use), acute brain injury, or recent thoracic surgery were exclusion criteria. Intubation was performed after failure of either oxygen supplementation alone or non-invasive respiratory support. Acute Batimastat physiologic status (Simplified Acute Physiology Score II) [16], preexistent illnesses (McCabe score) as non-fatal (score of 1), ultimately fatal (score of 2) or rapidly fatal disease (score of 3) [17] and chronic health evaluation (Knaus score) [18] were evaluated.Study designThe design of the study is shown in Figure Figure1.1.