Communications to the Editor |


Marin H. Kollef, MD, FCCP
Author and Funding Information

Associate Professor of Medicine Division of Pulmonary and Critical Care Medicine Washington University School of Medicine Director, Medical Intensive Care Unit Medical Director, Respiratory Therapy Barnes-Jewish Hospital St. Louis, MO

Chest. 1999;115(2):604-605. doi:10.1378/chest.115.2.604-b
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Published online

To the Editor:

Drs. Sfeir and Stefanec raises the point that we did not control adequately for the degree of lung injury in our linear regression model, which determined that the use of continuous IV sedation was associated with prolongation of mechanical ventilation. I agree with this conclusion. It is extremely difficult in a cohort study to prove causality between a potential risk factor and the outcome of interest. Such studies are primarily used to generate hypotheses or other questions for future investigation. Because of the results we obtained in this study, we subsequently performed a randomized controlled study examining the influence of protocolized sedation for the management of patients with acute respiratory failure. The main goal of this study was to determine whether a systematic approach to the administration of IV sedation to patients with acute respiratory failure requiring mechanical ventilation resulted in beneficial outcomes, including a reduction in the duration of mechanical ventilation. We have recently completed this study and hope to present its results in the near future.

Correspondence to: Marin H. Kollef, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Box 8052, St. Louis, MO 63110-1093; e-mail: mkollef@pulmonary.wustl.edu




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