Severe respiratory failure: advanced treatment options.
BACKGROUND
Severe respiratory failure (including acute lung injury and acute respiratory distress syndrome) continues to be associated with significant mortality and morbidity in patients of all ages.


OBJECTIVE
To review the laboratory and clinical data in support of and future directions for the advanced treatment of severe respiratory failure.


METHODS
MEDLINE/PubMed search of all relevant primary and review articles.


RESULTS
Our understanding of lung pathophysiology and the role of ventilator-induced lung injury through basic science investigation has led to advances in lung protective strategies for the mechanical ventilation support of patients with severe respiratory failure. Specific modalities reviewed include low-tidal volume ventilation, permissive hypercapnia, the open lung approach, recruitment maneuvers, airway pressure release ventilation, high-frequency oscillatory ventilation, prone positioning, and extracorporeal life support. The pharmacologic strategies (including corticosteroids, surfactant, and nitric oxide) investigated for the treatment of severe respiratory failure are also reviewed.


CONCLUSIONS
In patients with severe respiratory failure, an incremental approach to the management of severe hypoxemia requires implementation of the strategies reviewed, with knowledge of the evidence base to support these strategies.
Hemmila
Mark R
MR
Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
Napolitano
Lena M
LM
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D006935:Hypercapnia; D009569:Nitric Oxide / Q000627:therapeutic use; D016684:Prone Position; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D011663:Pulmonary Surfactants; D009569:Nitric Oxide