title: How ARDS should be treated.
abstract: The Berlin definition criteria applied at positive end-expiratory pressure (PEEP) 5 cm H2O reasonably predict lung edema and recruitabilty. To maintain viable gas exchange, the mechanical ventilation becomes progressively more risky going from mild to severe acute respiratory distress syndrome (ARDS). Tidal volume, driving pressure, flow, and respiratory rate have been identified as causes of ventilation-induced lung injury. Taken together, they represent the mechanical power applied to the lung parenchyma. In an inhomogeneous lung, stress risers locally increase the applied mechanical power. Increasing lung homogeneity by PEEP and prone position decreases the harm of mechanical ventilation, particularly in severe ARDS.
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany. gattinoniluciano@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
mesh_terms: D000818:Animals; D001604:Berlin; D004195:Disease Models, Animal; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*