Acute respiratory distress syndrome, the critical care paradigm: what we learned and what we forgot.
In the last several years, we definitely learned that the acute respiratory distress syndrome lung is small, nonhomogeneous, and that mechanical ventilation in this baby lung may cause physical damage as well as inflammatory reaction. The clinical benefit of the gentle lung treatment, based on a decrease of global/regional stress and strain into the lung, has been finally proved. However, we forgot the importance of lung perfusion and its distribution in this syndrome and, besides a low tidal volume, we still do not know how to handle the other variables of mechanical ventilation. Measurements of variables as transpulmonary pressure and end expiratory lung volume, for a rational setting of mechanical ventilation, should be introduced in routine clinical practice.
Gattinoni
Luciano
L
Istituto di Anestesia e Rianimazione, Universita' degli Studi di Milano, Ospedale Policlinico IRCCS, Milano, Italy. gattinon@policlinico.mi.it
Carlesso
Eleonora
E
Valenza
Franco
F
Chiumello
Davide
D
Caspani
Maria Luisa
ML
D006801:Humans; D008168:Lung / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology