Customization of an open-lung ventilation strategy to treat a case of life-threatening acute respiratory distress syndrome.
The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and F(IO(2)) table, and managing alveolar end-inspiratory pressure by limiting the plateau airway pressure to ≤ 30 cm H(2)O. Although this strategy, to date, is the only method that significantly improves ALI/ARDS survival, alternative methods of improving hypoxemia and minimizing ventilator-induced lung injury, in conjunction with low-tidal-volume ventilation, can be used for life-threatening ARDS. We present a case in which we customized the use of alveolar recruitment maneuvers by analyzing the hysteresis of the pressure-volume curve to assess lung recruitability, decremental PEEP to sustain lung recruitment, and careful use of plateau pressure ≥ 30 cm H(2)O, which improved our patient's life-threatening hypoxemia within the first 36 min of arrival to our ICU.
Sentara Norfolk General Hospital, Sentara Healthcare System, Norfolk, Virginia, USA. dxgrooms@sentara.com
David A
DA
Grooms
Stephen H
SH
Sibole
James R
JR
Tomlinson
Paul E
PE
Marik
Robert L
RL
Chatburn
D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*