Adjuncts to mechanical ventilation in ARDS.
Since its first description, acute respiratory distress syndrome has been characterized by abnormal physiologic and gas exchange properties of the lungs. Many adjunctive therapies have been developed to reduce the stresses of mechanical ventilation on already damaged lungs. We examined the mechanism of action and the latest clinical trial information of several adjunctive therapies including prone positioning, nitric oxide, extracorporeal membrane oxygenation, arterial venous carbon dioxide removal, and liquid ventilation. While all of these therapies have demonstrated short-term improvements in arterial blood gases and in the limitation of lung injury, none have shown an evidence-based survival benefit.
Lynch
James E
JE
Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77555, USA.
Cheek
J Mark
JM
Chan
Edward Y
EY
Zwischenberger
Joseph B
JB
D002245:Carbon Dioxide / Q000097:blood; D005112:Extracorporeal Circulation / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D021061:Liquid Ventilation; D009569:Nitric Oxide / Q000008:administration & dosage; D016684:Prone Position; D011659:Pulmonary Gas Exchange / Q000502:physiology; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume
D011663:Pulmonary Surfactants; D002245:Carbon Dioxide; D009569:Nitric Oxide