Ventilatory support in the acute respiratory distress syndrome

Ventilatory support in the acute respiratory distress syndrome (ARDS) has undergone considerable transformation in the 1990s. Current approaches include lung protective techniques which, while attempting to recruit and maintain lung volume, limit the shear stresses associated with ventilation by avo...

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Bibliographic Details
Published in:British medical bulletin 1999, Vol.55 (1), p.140-164
Main Authors: Keogh, Brian F, Ranieri, V Marco
Format: Article
Language:English
Subjects:
Humans
Lung Injury
Pulmonary Gas Exchange
Respiration, Artificial - adverse effects
Respiration, Artificial - methods
Respiratory Distress Syndrome, Adult - physiopathology
Respiratory Distress Syndrome, Adult - therapy
Respiratory Mechanics
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Summary:Ventilatory support in the acute respiratory distress syndrome (ARDS) has undergone considerable transformation in the 1990s. Current approaches include lung protective techniques which, while attempting to recruit and maintain lung volume, limit the shear stresses associated with ventilation by avoiding both alveolar overdistension and cyclical end-expiratory collapse. In addition, gas exchange targets have been liberalised and ventilatory conduct is much more tailored to individual pulmonary mechanics. Assessment of the inspiratory volume–pressure (V–P) curve provides information which can direct ventilator settings. Recent information from clinical trials has provided new insights into appropriate ventilatory modification and set the foundation for future clinical investigations.
ISSN:0007-1420
1471-8391
DOI:10.1258/0007142991902187