Advances in the management of acute respiratory distress syndrome: protective ventilation.

@article{Hirvela2000AdvancesIT,
  title={Advances in the management of acute respiratory distress syndrome: protective ventilation.},
  author={Elsa R. Hirvela},
  journal={Archives of surgery},
  year={2000},
  volume={135 2},
  pages={
          126-35
        }
}
  • E. Hirvela
  • Published 1 February 2000
  • Medicine, Engineering
  • Archives of surgery
The approach to mechanical ventilation has been revolutionized by new insights into the pathogenesis of respiratory failure in acute respiratory distress syndrome (ARDS). Concepts such as low-volume ventilation, permissive hypercapnia, inverse ratio ventilation, best and intrinsic positive end-expiratory pressure, airway shear, pressure volume curves, inflection points, and prone positioning have radically transformed thinking about ventilator management. Since 1966, more than 8000 ARDS-related… 
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23 Citations

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Citation Type

Pressure Controlled, Inverse Ratio Mechanical Ventilation
For patients with acute respiratory distress syndrome (ARDS) and other forms of acute lung injury, high levels of ventilatory support are required while the lungs recover. However, despite all the…
Acute respiratory distress syndrome.
TLDR
The management of acute respiratory distress syndrome frequently requires endotracheal intubation and mechanical ventilation, and advanced ventilator and novel techniques should be considered, preferably in the setting of clinical trials.
Surgical Intensive Care Unit
TLDR
“Less is more” characterizes the trends in ventilation strategies, and NPPV may avoid intubation and decrease the risk of nosocomial pneumonia in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).
[The assessment of severity of lung injury in sepsis].
TLDR
Assessment of the severity of the lung injury in patients who had suffered from sepsis of the gynecological origin and its influence on the outcome of the disease indicates that high values of the Lung injury score are suggestive of the severe respiratory dysfunction as well as that lethal outcome is dependent on LIS value.
Partial liquid ventilation with perfluorocarbons for treatment of ARDS in burns.
State-of-the-art therapy for severe sepsis and multisystem organ dysfunction.
  • S. Awad
  • Medicine
    American journal of surgery
  • 2003
Respiratory failure in interstitial lung disease
TLDR
The prognosis and treatment may vary according to the type of ILD and the cause of the respiratory failure, which must therefore be established before treatment is initiated.
Blunt chest trauma: review of selected pulmonary injuries focusing on pulmonary contusion.
TLDR
The epidemiology and mechanism of injury most often observed in patients with blunt chest trauma are reviewed and a case study is presented highlighting a complicated case of a blunt chest injury resulting in severe pulmonary contusion.
Noninvasive motion ventilation (NIMV): a novel approach to ventilatory support.
TLDR
A novel motion platform is described that imparts periodic sinusoidal acceleration forces at moderate frequencies (4 Hz) to the whole body in the z-plane, capable of highly effective ventilation of normal and diseased lungs.
Development of a Paracorporeal Respiratory Assist Lung (PRAL)
TLDR
It is found that the roughness of the rotating fibers was the cause of much of the blood trauma of the PRAL, and the gas exchange efficiency of the device at constant flowrate was enhanced, therebyuncoupling gas exchange and flowrate.
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References

SHOWING 1-10 OF 50 REFERENCES
Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.
TLDR
As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome.
Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome.
Mechanical ventilation may promote overdistension-induced pulmonary lesions in patients with acute respiratory distress syndrome (ARDS). The static pressure-volume (P-V) curve of the respiratory…
Low mortality rate in adult respiratory distress syndrome using low‐volume, pressure‐limited ventilation with permissive hypercapnia: A prospective study
TLDR
The hypothesis that limitation of peak inspiratory pressure and reduction of regional lung overdistention by the use of low tidal volumes with permissive hypercapnia may reduce ventilator‐induced lung injury and improve outcome in severe ARDS is supported by a large body of experimental evidence.
Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome.
TLDR
It is concluded that improvement of oxygenation during pressure-controlled mechanical ventilation in the prone position is due to a shift of blood flow away from shunt regions, thus increasing areas with normal VA/Q.
Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group.
TLDR
In patients at high risk for the acute respiratory distress syndrome, a strategy of mechanical ventilation that limits peak inspiratory pressure and tidal volume does not appear to reduce mortality and may increase morbidity.
Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome
TLDR
The data suggest that prone positioning should be carried out early in the course of ARDS, and that turning critically ill, severely hypoxemic patients from the supine to the prone position is a safe and useful therapeutic intervention.
Prone postioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS.
TLDR
It is assumed that the low mortality in patients with severe ARDS might be due mainly to low-volume pressure-limited ventilation and prone positioning, which seems to allow successful treatment for patients withsevere ARDS.
Should inverse ratio ventilation be used in adult respiratory distress syndrome?
TLDR
There is little evidence to indicate that oxygenation can be maintained or improved with IRV while volotrauma risk is reduced, and IRV remains of unproven value in the management of ARDS.
Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome.
TLDR
The prone position can improve oxygenation in severely hypoxemic ARDS patients without deleterious effects on hemodynamics and Repeated daily trials in the prone position should be considered in the management of AR DS patients with severe hypoxemia.
The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome.
TLDR
The American-European Consensus Committee on ARDS was formed to re-evaluate the standards for the ICU care of patients with acute lung injury (ALI), with regard to ventilatory strategies, the more promising pharmacologic agents, and the definition and quantification of pathologic features of ALI that require resolution.
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