Abstract
Despite new promising therapeutic interventions including protective ventilation, prone positioning, use of neuromuscular blockers and conservative fluid balance, acute respiratory distress syndrome (ARDS) remains a devastating disease [1, 2]. Mortality rates for ARDS have decreased over time but still remain around 40%, in large part a result of the hemodynamic complications of this syndrome [3]. ARDS has various etiologies and early diagnosis and intervention are key to improving outcomes [4]. Dominant features of ARDS include injury to the alveolar-capillary membrane, which results in severe hypoxemia, decrease in pulmonary compliance, and increase in pulmonary vascular resistance [5, 6]. At present, positive-pressure mechanical ventilation is the mainstay of symptomatic treatment for ARDS [1], but may further increase pulmonary hypertension and right ventricular (RV) afterload, leading to acute cor pulmonale and RV failure [6]. Moreover, mechanical ventilation induces additional lung injuries due to overdistention, repeated stretch to the alveoli, atelectotrauma, and increased inflammatory mediator levels [7]. The ARDSNet study reported a reduction in mortality with a ventilation strategy involving limitation of mean tidal volume to 6 ml/kg, as compared with a more traditional tidal volume of 12 ml/kg [1]. However, utilization of lower tidal volumes leads to permissive hypercapnia and most clinicians seldom use very low tidal volumes in practice. Indeed, the need to substantially reduce tidal volume to improve outcome in ARDS patients remains questionable because of the deleterious effects of hypercapnia [8]. In addition, lung injury persists even when tidal volumes are small [9] and further reduction in tidal volume beyond those recommended by ARDSNet may have outcome benefits [10], although not all agree [11]. Thus, modern care for ARDS requires a decision to maximally reduce ventilator settings to ensure lung protection and reduce exacerbation of lung injury while facing the metabolic consequences of this intervention. How can we enhance lung protection in ARDS while not causing metabolic disturbances?
Keywords
- Right Ventricular
- Tidal Volume
- Acute Respiratory Distress Syndrome
- Acute Respiratory Distress Syndrome Patient
- Right Ventricular Failure
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Morimont, P., Batchinsky, A., Lambermont, B. (2015). Update on the Role of Extracorporeal CO2 Removal as an Adjunct to Mechanical Ventilation in ARDS. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_15
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