Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS
The acute respiratory distress syndrome (ARDS) is a hypoxemic syndrome primarily treated using supportive mechanical ventilation. Although mechanical ventilation is life-saving, it can cause ventilator-induced lung injury (VILI). Therefore, the goal of mechanical ventilation is to achieve adequate gas exchange while minimizing lung injury. Multiple mechanical ventilation strategies have been developed to limit VILI. These strategies are based on the pathophysiological concept that alveolar overdistention, shear-stress, and atelectrauma (i.e., the cyclical opening and closing of unstable alveoli) are possible mechanisms that result in VILI. Targets that might aggravate or attenuate VILI, notably tidal volume and positive end-expiratory pressure (PEEP), have become the subject of extensive research.
We thank Nathalie Timmerman for her support in the preparation of figures.
- 16.Caironi P, Carlesso E, Cressoni M, et al. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cmH2O rather than higher positive end-expiratory pressure: a retrospective cohort study. Crit Care Med. 2015;43:781–90.CrossRefGoogle Scholar
- 25.Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253–63.CrossRefGoogle Scholar
- 32.Hasan D, Satalin J, van der Zee P, et al. Excessive extracellular ATP desensitizes P2Y2 and P2X4 ATP receptors provoking surfactant impairment ending in ventilation-induced lung injury. Int J Mol Sci. 2018;19:1185.Google Scholar