Abstract
A 25-year-old female patient presented with fever with chills and vomiting. The following day, she noted increased difficulty in breathing. Extensive bilateral infiltrates were seen on the chest X-ray, and she needed supplemental oxygen to maintain oxygen saturation at more than 90%. Echocardiography showed normal cardiac function. She was getting progressively fatigued and increasingly drowsy and was intubated.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading and Important Trials
Briel M, Meade M, Mercat A, et al. Higher versus lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303:865–73. Treatment with higher vs lower levels of PEEP was not associated with improved hospital survival. However, higher levels were associated with improved survival among the subgroup of patients with severe ARDS
Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351:327–36. ARDS who receive mechanical ventilation with tidal-volume goal of 6 ml per kilogram of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm of water a, clinical outcomes are similar with lower or higher PEEP levels
Guérin C, Reignier J, Richard JC, et al. for the PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68. In severe ARDS, early application of prone-positioning for 1 to 20 hrs significantly decreased 28-day and 90-day mortality
Meade MO, Cook DJ, Guyatt GH, et al. Lung Open Ventilation Study Investigators. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:637–45. For patients with ARDS, a multifaceted protocolized ventilation strategy designed to recruit and open the lung resulted in no significant difference in all-cause hospital mortality or barotrauma However it improved secondary end points related to hypoxemia and use of rescue therapies
Mercat A, Richard JC, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. Expiratory Pressure (Express) Study Group. JAMA. 2008;299:646–55. A strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation did not significantly reduce mortality. However, it did improve lung function and reduced the duration of mechanical ventilation and the duration of organ failure
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354:2213–24. PAC-guided therapy did not improve survival or organ function but was associated with more complications than CVC-guided therapyin ARDS patients
Patroniti N, Isgrò S, Zanella A. Clinical of severely hypoxemic patients. Critical Care. 2011;17:50–6. A review article on therapies for refractory hypoxemia
Pipeling MR, Fan E. Therapies for refractory hypoxemia in acute respiratory distress syndrome. JAMA. 2010;304:2521–7.
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8. In ARDS patient, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days off ventilation
The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-2533. https://doi.org/10.1001/jama.2012.5669. An article on new Berlin definition
The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network∗. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75. The conservative strategy of fluid management improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures
Websites
http://www.ardsnet.org. The official website of the ARDS Network, initiated by National Heart, Lung, and Blood Institute and National Institutes of Health to carry out multicenter clinical trials of ARDS treatments
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kapadia, F.N., Bhutada, U. (2020). Mechanical Ventilation in Acute Respiratory Distress Syndrome. In: Chawla, R., Todi, S. (eds) ICU Protocols. Springer, Singapore. https://doi.org/10.1007/978-981-15-0898-1_6
Download citation
DOI: https://doi.org/10.1007/978-981-15-0898-1_6
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-0897-4
Online ISBN: 978-981-15-0898-1
eBook Packages: MedicineMedicine (R0)