title: [Current approaches to the treatment of severe hypoxic respiratory insufficiency (acute lung injury; acute respiratory distress syndrome)].
abstract: Lung-protective ventilation with a low tidal volume, plateau pressure < 30 cm H(2)O. oxygen saturation > 90% and permissive hypercapnia results in reduction of the mortality rate in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The level of the positive end-expiratory pressure (PEEP) must be chosen in relation to oxygen requirement. High frequency oscillatory ventilation and neurally adjusted ventilatory assist are promising methods. However, further studies with firm end-points have to be awaited before a final judgment is possible. Veno-venous extracorporeal membrane oxygenation (ECMO) can ensure life-sustaining gas exchange in patients with severe vitally compromised pulmonary failure, to provide time for lung tissue to heal and reduce ventilatory stress. The latest guidelines for analgesia and sedation in intensive care medicine demand consistent monitoring of the level of sedation and the intensity of pain. The sedation should be interrupted daily, with phases of awakenings and, if possible, spontaneous breathing. Methods of supportive treatment: Positional treatment (prone position) and inhalation of vasodilators can improve ventilation/perfusion mismatch and thus oxygenation. However, administration of surfactant is currently not advised in adult respiratory failure.
authors.affiliation: Klinik für Intensivmedizin, Universitätklinikum Eppendorf, Hamburg.
authors.forename: S
authors.initials: S
authors.lastname: Kluge
authors.forename: T
authors.initials: T
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Pfeifer
mesh_terms: D055371:Acute Lung Injury / Q000401:mortality / Q000628:therapy*; D000328:Adult; D003131:Combined Modality Therapy; D016292:Procedural Sedation; D003422:Critical Care / Q000379:methods; D003964:Diaphragm / Q000294:innervation; D004576:Electromyography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000628:therapy*; D010147:Pain Measurement; D011175:Positive-Pressure Respiration / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013813:Therapy, Computer-Assisted