Alternative protocol to initiate high-frequency oscillatory ventilation: an experimental study

INTRODUCTION: The objective was to study the effects of a novel lung volume optimization procedure (LVOP) using high-frequency oscillatory ventilation (HFOV) upon gas exchange, the transpulmonary pressure (TPP), and hemodynamics in a porcine model of surfactant depletion. METHODS: With institutional review board approval, the hemodynamics, blood gas analysis, TPP, and pulmonary shunt fraction were obtained in six anesthetized pigs before and after saline lung lavage. Measurements were acquired during pressure-controlled ventilation (PCV) prior to and after lung damage, and during a LVOP with HFOV. The LVOP comprised a recruitment maneuver with a continuous distending pressure (CDP) of 45 mbar for 2.5 minutes, and a stepwise decrease of the CDP (5 mbar every 5 minute) from 45 to 20 mbar. The TPP level was identified during the decrease in CDP, which assured a change of the PaO2/FIO2 ratio < 25% compared with maximum lung recruitment at CDP of 45 mbar (CDP45). Data are presented as the median (25th-75th percentile); differences between measurements are determined by Friedman repeated-measures analysis on ranks and multiple comparisons (Tukey's test). The level of significance was set at P < 0.05. RESULTS: The PaO2/FiO2 ratio increased from 99.1 (56.2-128) Torr at PCV post-lavage to 621 (619.4-660.3) Torr at CDP45 (CDP45) (P < 0.031). The pulmonary shunt fraction decreased from 51.8% (49-55%) at PCV post-lavage to 1.03% (0.4-3%) at CDP45 (P < 0.05). The cardiac output and stroke volume decreased at CDP45 (P < 0.05) compared with PCV, whereas the heart rate, mean arterial pressure, and intrathoracic blood volume remained unchanged. A TPP of 25.5 (17-32) mbar was required to preserve a difference in PaO2/FIO2 ratio < 25% related to CDP45; this TPP was achieved at a CDP of 35 (25-40) mbar. CONCLUSION: This HFOV protocol is easy to perform, and allows a fast determination of an adequate TPP level that preserves oxygenation. Systemic hemodynamics, as a measure of safety, showed no relevant deterioration throughout the procedure.

El Capítulo de Inversiones en el Acuerdo de Asociación Transpacífico:¿Una Posibilidad de Cambio y Convergencia?

Spanish Abstract: El presente trabajo analiza los posibles efectos que generaría en la regulación internacional de la inversión extranjera, el acuerdo de un capítulo de inversiones en el Acuerdo de Asociación Transpacífico (TPP), actualmente en negociaciones, sobre la base de la información disponible a la fecha. El artículo aborda cuatro aspectos que presentan especial importancia dada la divergencia de intereses entre algunos de los Estados negociadores: el ámbito de protección de la inversión extranjera; las normas sobre transparencia de los regímenes de inversión y sus disputas; la irrupción de entidades estatales como inversionistas extranjeros; y la solución de controversias a través del arbitraje inversionista-Estado. El autor concluye que en comparación a la actual fragmentación regulatoria de la que dan cuenta los acuerdos internacionales de inversión suscritos por los países negociadores del TPP, la incorporación de un capítulo de inversiones en ese Acuerdo es una oportunidad para avanzar en la convergencia de la regulación sobre inversión extranjera, tanto en materia de estándares sustantivos de protección de la inversión como en la mejora del arbitraje inversionista-Estado como mecanismo de solución de controversias.

The Road to Bali: ERIA Perspectives on the WTO Ministerial and Asian Integration

The World Trade Organization’s (WTO) forthcoming Ninth Ministerial Conference in Bali comes at a critical juncture for the multilateral trade body, long mired in the Doha Round stalemate. Beyond offering a critical first test at consensus-building and institutional renewal, the Bali Ministerial affords a unique opportunity to gauge contrasting perceptions across ASEAN and East Asian countries of the continued relevance of the WTO to trade and economic governance within the region and beyond. Resulting from the collaborative efforts of the Economic Research Institute for ASEAN and East Asia (ERIA), the Universitas Pelita Harapan (UPH) and the World Trade Institute at the University of Bern (WTI), this policy research initiative offers comparative scholarship on some of the key questions arising from the forthcoming WTO Ministerial gathering from an East Asian perspective. Specifically, it explores what scholars in the region expect the Bali Ministerial to produce by way of tangible outcomes and whether the Ministerial will restore the momentum needed to bring the Doha Round to a successful conclusion. Contributors also investigate how relevant the WTO remains to the multiple processes of deepening economic integration in ASEAN and East Asia (e.g. AEC, TPP, RCEP) and, importantly, what lessons in rule-design and market opening WTO Members could usefully draw from the ongoing march towards the establishment of an ASEAN Economic Community.