TY  - CHAP
M1  - Book, Section
TI  - Controversies: Ventilator Management in ARDS: One Size Fits All?
A1  - Adrish, Muhammad
A1  - Soto, Graciela J.
A2  - Oropello, John M.
A2  - Pastores, Stephen M.
A2  - Kvetan, Vladimir
PY  - 1
T2  - Critical Care
AB  - KEY  POINTSThe  pathophysiologic  changes  in  the  acute  respiratory  distress  syndrome  (ARDS)  produce  low-compliant  lungs  containing  areas  of  atelectasis  and  reduced  lung  volumes.Positive  pressure  ventilation  in  this  heterogenous  syndrome  can  lead  to  overdistension  of  normally  aerated  lung  regions  and  stress  injury  in  atelectatic  alveoli  due  to  cyclic  recruitment  and  derecruitment.Use  of  low-tidal-volume  ventilation  as  lung-protection  strategy  has  been  studied  since  1960s.  Despite  suggested  benefits,  concerns  regarding  additional  metabolic  abnormalities  and  hypoxemia  in  critically  ill  patients  have  existed.Results  of  the  landmark  ARDS  in  a  large  multicentre  randomized  trial  found  that  the  use  of  low  tidal  volume  (6  mL/kg  ideal  body  weight  [IBW])  rather  than  “standard”  tidal  volume  (12  mL/kg  IBW)  significantly  reduced  mortality.  Although  the  trial  was  criticized  for  using  excessively  large  tidal  volumes  in  controls,  the  trial  investigators  subsequently  published  trial  data  detailing  the  clinical  benefits  of  tidal  volume  and  plateau  pressure  reduction  across  the  range  of  disease  severity  and  plateau  pressures.Recent  data  suggest  that  many  mechanically  ventilated  patients  with  ARDS  have  stress  index  that  indicates  alveolar  hyperventilation  while  receiving  positive  end-expiratory  pressure  (PEEP)  according  to  the  ARDS  Network  recommendation,  advocating  even  lower  tidal  volumes.Use  of  adjunct  therapies  such  as  extracorporeal  membrane  oxygenation  may  be  useful  in  select  patients  where  lowering  tidal  volume  can  lead  to  serious  metabolic  abnormalities.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1136418213
ER  -