Abstract
This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients.
Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmH2O is recommended in all patients. It is suggested that a plateau pressure <15 cmH2O should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive end-expiratory pressure (PEEP). Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lung-protective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected.
Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit.
Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising.
Abstract
Treatment of ARDS is mainly through the prevention of ventilation-induced lung injury http://ow.ly/DeJC30hGWfi
Footnotes
Number 1 in the Series “Highlights in acute respiratory failure” Edited by Leo Heunks and Raffaele Scala
Support statement: Funding was received from the European Respiratory Society (short-term fellowship) and Longfonds (junior investigator grant). Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at err.ersjournals.com
Provenance: Commissioned article, peer reviewed.
- Received September 20, 2017.
- Accepted December 13, 2017.
- Copyright ©ERS 2018.
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