title: Nonconventional support of respiration.
abstract: OBJECTIVE
  Several alternative treatments have been proposed to decrease mortality of patients with acute respiratory distress syndrome (ARDS). We will discuss most recent trials and meta-analysis studies on nonconventional ventilatory and pharmacological treatments of ARDS patients.
  
  
  RESULTS
  Nonconventional ventilatory treatments such as prone positioning, high frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO) aim to restore gas exchange while further decreasing ventilator induced lung injury. Though randomized trials failed to prove survival benefits with the use of prone positioning or HFOV, recent meta-analyses have shown, for both treatments, a decrease in mortality in the subpopulation of more severe ARDS patients. In a randomized controlled trial, referral of ARDS patients in a center with experience on ECMO was associated with an improved survival rate. Promising results come from new miniaturized extracorporeal techniques optimized for effective CO(2) removal from low blood flow. These techniques should allow early application of superprotective ventilator strategies. Pharmacological treatments such as neuromuscular blocking and intravenous β2 agonist may be effective in specific times and subsets of patients.
  
  
  CONCLUSIONS
  Existing data suggest that some of the available nonconventional treatments may be effective in more severe ARDS patients. New techniques and drugs that should facilitate prevention or healing of lung injury are under investigation.
authors.affiliation: Department of Experimental Medicine, University of Milano-Bicocca, Monza, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D006612:High-Frequency Ventilation; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000628:therapy*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D009466:Neuromuscular Blocking Agents