Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS.
Keenan Research Centre, St Michael's Hospital, Toronto, ON, Canada Division of Respiratory Diseases and Tuberculosis, Dept of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Nuttapol
N
Rittayamai
Keenan Research Centre, St Michael's Hospital, Toronto, ON, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Laurent
L
Brochard
D006801:Humans; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000517:prevention & control / Q000628:therapy*