Update in ARDS management: recent randomized controlled trials that changed our practice.
In the last 7 years, 14 randomized controlled trials in patients with acute respiratory distress syndrome (ARDS) have shown that: Mechanical ventilation with a tidal volume of 6 mL/kg of predicted body weight is better than mechanical ventilation with a tidal volume of 12 mL/kg of predicted body weight. Prone positioning improves oxygenation but poses safety concerns. A high level of positive end-expiratory pressure does not improve survival. High-frequency oscillatory ventilation is in theory the ideal "lung-protective" method, but its benefits have not been proven. No drug therapy has been shown to improve survival in patients with ARDS. Exogenous surfactant may improve oxygenation but has no significant effect on the death rate or length of use of mechanical ventilation. Low-dose inhaled nitric oxide has no substantial impact on the duration of ventilatory support or on the death rate. Partial liquid ventilation may be beneficial in young patients with acute lung injury or ARDS, although further study is needed to confirm this.
Department of General Internal Medicine, The Cleveland Clinic Foundation, OH 44195, USA.
J Fernando
JF
Santacruz
Enrique
E
Diaz Guzman Zavala
Alejandro C
AC
Arroliga
D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006612:High-Frequency Ventilation; D006801:Humans; D021061:Liquid Ventilation; D009569:Nitric Oxide / Q000627:therapeutic use; D009820:Ohio; D011175:Positive-Pressure Respiration / Q000379:methods; D016684:Prone Position; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000628:therapy*; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D015996:Survival Rate; D013990:Tidal Volume
D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; D009569:Nitric Oxide; C069195:sivelestat; D005998:Glycine