title: Spontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome.
abstract: OBJECTIVE
  This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS).
  
  
  RESULTS
  Spontaneous breathing during assisted as well as nonassisted modes of mechanical ventilation improves lung function and reduces lung damage in mild and moderate ARDS. New modes of assisted mechanical ventilation with improved patient ventilator interaction and enhanced variability of the respiratory pattern offer additional benefit on lung function and damage. However, data supporting an outcome benefit of spontaneous breathing in ARDS, even in its mild and moderate forms, are missing. In contrast, controlled mechanical ventilation with muscle paralysis in the first 48 h of severe ARDS has been shown to improve survival, as compared with placebo. Currently, it is unclear whether ventilator settings, rather than the severity of lung injury, determine the potential of spontaneous breathing for benefit or harm.
  
  
  CONCLUSIONS
  Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.
authors: aPulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany bDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
authors: Andreas
authors: A
authors: Güldner
authors: Paolo
authors: P
authors: Pelosi
authors: Marcelo
authors: M
authors: Gama de Abreu
mesh_terms: D000818:Animals; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D011659:Pulmonary Gas Exchange; D012119:Respiration; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012720:Severity of Illness Index; D013990:Tidal Volume; D015300:Ventilator Weaning; D055397:Ventilator-Induced Lung Injury / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy