Controlled airway pressure therapy, nitric oxide inhalation, prone position, and extracorporeal membrane oxygenation (ECMO) as components of an integrated approach to ARDS.

  title={Controlled airway pressure therapy, nitric oxide inhalation, prone position, and extracorporeal membrane oxygenation (ECMO) as components of an integrated approach to ARDS.},
  author={Roman Ullrich and C. Lorber and G R{\"o}der and Georg Urak and Barbara Faryniak and Robert N. Sladen and Peter Germann},
  volume={91 6},
BACKGROUND Recent years have seen the introduction of innovative additive therapies for acute respiratory distress syndrome. [] Key MethodMETHODS During a 2.5-yr period, 84 patients with acute respiratory distress syndrome were assigned to a standardized treatment protocol. Data analysis was performed by retrospective review of patient charts.

Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome*

INO delivered at doses of 5 to 20 ppm during high-frequency oscillatory ventilation increases Pao2/Fio2 and may be a safe and effective rescue therapy for patients with severe oxygenation failure.

Trends in and perspectives on extracorporeal membrane oxygenation for severe adult respiratory failure

Clinical usefulness of ECMO was documented in many cases of severe ARDS secondary to influenza A (H1N1) 2009 infection, and ECMO can be expected to gain importance as a respiratory support technique.

P-V approach revisited.

Clinical experience with the pressure–volume approach of the 1980s and recent scientific evidence should have the desired impact on ventilation strategy in critical care units, and it is hoped to gain more clinical experience from such studies to help us incritical care medicine in the 21st century.

Insertion of a Fogarty Catheter through an Endotracheal Tube for One-lung Ventilation : A New Method

Although this first evidence of lung volume–oriented ventilation did not receive a good response, Ullrich et al. supported this approach in their large-scale clinical study.

Interventional Lung Assist – Effective Removal of Carbon Dioxide in Acute Respiratory Failure

In the most severe cases of acute respiratory failure profound hypoxaemia or respiratory acidosis may contradict the sole use of protective ventilation strategies and necessitate additional strategies such as positioning manoeuvres, inhaled vasodilators, partial liquid ventilation or high-frequency ventilation techniques.

Mechanical ventilation during extracorporeal life support (ECLS): a systematic review

Reduction in the intensity of mechanical ventilation in patients with ARDS supported by ECLS is common, suggesting that clinicians may be focused on reducing VILI after ECLs initiation.

Mechanical ventilation in acute respiratory distress syndrome

The acute respiratory distress syndrome occurs commonly in critical care. There is an increasing volume of clinical and experimental evidence that poor ventilatory technique that is injurious to the



Additive Effect of Nitric Oxide Inhalation on the Oxygenation Benefit of the Prone Position in the Adult Respiratory Distress Syndrome

In patients with isolated severe adult respiratory distress syndrome, inhalation of nitric oxide in the prone position significantly improved oxygenation compared withNitric oxide inhalation in the supine position or in theprone position without nitricoxide.

Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome.

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.

Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.

It is concluded that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups, and extracordoreal support for ARDS should be restricted to controlled clinical trials.

Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.

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.

Interest of a therapeutic optimization strategy in severe ARDS.

In patients with severe ARDS, the response to an early performed therapeutic optimization used to improve hypoxemia appeared to be a highly discriminant factor distinguishing deceased from surviving patients.

Low mortality rate in adult respiratory distress syndrome using low‐volume, pressure‐limited ventilation with permissive hypercapnia: A prospective study

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.

Inhaled nitric oxide for the adult respiratory distress syndrome.

Inhalation of nitric oxide by patients with severe adult respiratory distress syndrome reduces the pulmonary-artery pressure and increases arterial oxygenation by improving the matching of ventilation with perfusion, without producing systemic vasodilation.

A successful computerized protocol for clinical management of pressure control inverse ratio ventilation in ARDS patients.

The success of this protocol has demonstrated the feasibility of using PEEPi as a primary control variable for oxygenation and should make the future use of PCIRV less mystifying, simpler, and more systematic.

Effects of inhaled nitric oxide and extracorporeal membrane oxygenation on pulmonary hemodynamics and lymph flow in oleic acid lung injury in sheep.

In an oleic acid-induced sheep model of acute lung injury, there were significant differences between the effects of NO and ECMO on acute pulmonary hypertension, hypoxemia, hypercarbia, and lymph flow.

Pressure controlled inverse ratio ventilation in severe adult respiratory failure.

It is suggested that PC-IRV can be successfully and safely implemented in critically ill patients with severe respiratory failure over prolonged periods of time resulting in significant improvement in oxygenation at lower minute volume, peak airway pressure and PEEP requirements.