Info for the General Public

Ten questions about the PROVE Network

What are lungs?
Lungs are organs in the chest that allow your body to take oxygen from inspired air and remove carbon dioxide (a gas that can be toxic) in expired air. Breathing, i.e., inspiration plus expiration, is a vital function of life and helps your body to work properly. 

What is mechanical ventilation and why I need it?
Mechanical ventilation (MV) is a method to mechanically assist or replace spontaneous breathing. This involves a machine called mechanical ventilator, which pushes the air into the lungs (inspiration), usually via a plastic tube placed in the central airway between the vocal cords. Expiration than follows spontaneously. 
Mechanical ventilation is indicated and sometimes even lifesaving when the patient’s spontaneous breathing is inadequate to maintain life (e.g., in critically ill patients) or when the spontaneous breathing is purposely abolished, like with general anesthesia (e.g., for surgery). 

Mechanical ventilation can cause harm?
Yes, despite being a lifesaving strategy mechanical ventilation can cause harm, in the lungs and beyond. Our lungs are not adapted to work on a ventilator and so our body reacts releasing some substances that may cause injury direct in the lungs and in other organs. 

There is any way in avoiding this harm?
There are some strategies that can lower harm of mechanical ventilation. First of all, the best thing to do is to keep the patient of the ventilator, or on the ventilator the shortest time possible. Also, there are some specific adjustments on the ventilator settings that can decrease the harm of the ventilator on the lungs. 

What is the PROVENet?
The PROtective VENtilation Network (‘PROVENet’) is a clinical research network that aims to find and test which ventilatory settings and strategies are the best for the good health of the lungs of critically ill patients who need mechanical ventilation, and patients who need mechanical ventilation because of general anesthesia for surgery. The main body of this network is the Steering Committee that is responsible for identification of promising strategies, development of protocols, definition of priorities, facilitation and monitoring the trials, and to report study results. 

Why PROVENet is import?
The main aim of PROVENet is the identification of strategies that have the potential to decrease or maybe even prevent harm of mechanical ventilation to the lungs. The importance of this is that, decreasing or preventing harm of mechanical ventilation it is possible to decrease complications, and by this the time that the patient stays in the intensive care unit and/or the hospital and even mortality of those undergoing this type support. 

What PROVENet does?
PROVENet designs and conducts observational studies and clinical trials that focus on mechanical ventilation strategies that could decrease or prevent harm of mechanical ventilation. An observational study draws inferences about possible effects of a treatment in patients, where the assignment of patients into a treated group versus a control group is outside the control of the investigator (i.e., there is no intervention). A trial is a set of tests in medical research that generates safety and efficacy data for health interventions. All the trials of the PROVENet are conducted only after satisfactory information has been gathered on the quality of the nonclinical safety, and health authority/ethics committee approval is granted in the country where the trial will be realized. 

Which patients can be enrolled in PROVENet studies and trials?
Studies and trials of the PROVENet enroll patients in the intensive care unit and patients undergoing general anesthesia for surgery. Studies and trials focus on all patients, with or without already existing lung injury. 

What PROVENet already did for me?
Recently the PROVENet conducted the largest trial on mechanical ventilation for patients undergoing general anesthesia for surgery. With the results of this trial, it is possible to identify factors associated with complications and then develop strategies to avoid it. 
Also, PROVENet was responsible for a study that shows that a specific strategy of mechanical ventilation can decrease the harm of the ventilator. With this result, ICU physicians around the world start to use this strategy in their patients. 

What is PROVENet doing right now?
The PROVENet is conducting diverse studies on important fields of mechanical ventilation. Some examples include ‘PRoVENT’, ‘PROBESE’ and ‘PROVAR’ PRoVENT (‘Practice of VENTilation in critically ill patients without ARDS’) is an international observational study into the outcomes and ventilatory parameters of patients under mechanical ventilation in intensive care unit patients. PROBESE (PROtective ventilation in OBESE patients) is a randomized controlled trial that compares a strategy of ventilation using higher airway pressures with a strategy with lower airway pressures in obese patients undergoing general anesthesia for surgery. PROVAR (‘PROtective VARiable ventilation trial’) is a randomized controlled trial that compares fixed ventilation with variable ventilation in patients scheduled for open abdominal surgery. Other examples can be found via the link ‘PROJECTS’.