title: Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited.
abstract: Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. In this regard, ventilator-associated lung injury (VALI) is the main concern when this technique is used. The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them. Lastly, a series of knowledge-based recommendations are proposed that can be helpful for the ventilator assisted management of ARDS at the patient bedside.
authors.affiliation: Unidad de Gestión Clínica de Medicina Intensiva, Hospital Valle del Nalón, Langreo, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Amado-Rodríguez
authors.affiliation: Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Del Busto
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: E
authors.initials: E
authors.lastname: García-Prieto
authors.affiliation: Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain. Electronic address: Guillermo.muniz@sespa.es.
authors.forename: G M
authors.initials: GM
authors.lastname: Albaiceta
mesh_terms: D017097:Electric Impedance; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008991:Monitoring, Physiologic; D011175:Positive-Pressure Respiration; D049268:Positron-Emission Tomography; D016684:Prone Position; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D014054:Tomography; D014057:Tomography, X-Ray Computed; D055397:Ventilator-Induced Lung Injury / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D014939:Work of Breathing
keywords: Acute respiratory distress syndrome; Lesión pulmonar asociada a ventilador; Mechanical ventilation; Síndrome de dificultad respiratoria aguda; Ventilación mecánica; Ventilator-associated lung injury