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Tracheal Gas Insufflation in ARDS

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine 1997

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1997))

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Abstract

The mortality of the adult respiratory distress syndrome (ARDS) remains high and the role of mechanical ventilation in worsening the lung injury is assumed [1]. Conventional mode of ventilation aimed to obtain “normal” pulmonary function as reflected by arterial blood gases, and some lung injury was accepted as an inevitable consequence. This type of ventilatory support is frequently associated with high airway pressures and volumes for effective ventilation which, in turn, may worsen lung injury [2, 3]. Optimal ventilation would be the mode achieving adequate gas exchange without increasing the risk of ventilator-induced barotrauma [4, 5]. New strategies have been developed to prevent the lungs exposure to high pressures [6, 7]. These modes of ventilation lowering minute ventilation allows “abnormal” respiratory function with hypercapnia. Preliminary studies have reported improved survival with this new approach [6, 7]. However, there are no conclusive data indicating that any ventilatory mode is superior to the others for ARDS patients. Moreover, in patients with severe lung injury, total lung capacity may be so reduced that lung overinflation with excessive regional lung volumes may persist even when pressures and volumes are limited. Tolerance of hypercapnia is also still questionable, especially in patients that are not able to compensate for the respiratory acidosis because of coexistent acute renal failure or multiple organ failure or in those who have associated brain damage [8]. Low tidal volumes and pressures may also fail to achieve adequate arterial oxygenation needing increase in FiO2 with potential increase in oxygen toxicity.

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Authors
  1. F. Brunet
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  2. M. Monchi
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  3. J. Dall’ava Santucci
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Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Clinical Director) (Clinical Director)

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© 1997 Springer-Verlag Berlin Heidelberg

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Brunet, F., Monchi, M., Santucci, J.D. (1997). Tracheal Gas Insufflation in ARDS. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1997. Yearbook of Intensive Care and Emergency Medicine, vol 1997. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-13450-4_47

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  • DOI: https://doi.org/10.1007/978-3-662-13450-4_47

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-13452-8

  • Online ISBN: 978-3-662-13450-4

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