Ventilation Strategy Using Low Tidal Volumes, Recruitment Maneuvers, and High Positive End-Expiratory Pressure for Acute Lung Injury and Acute Respiratory Distress Syndrome

Abstract

CUTE LUNG INJURY AND ACUTE respiratory distress syndrome (ARDS, the most severe form of acute lung injury), are potentially devastating complications of critical illness. 1 Arising in response to direct lung injury (eg, pneumonia) or intense systemic inflammation (eg, sepsis), 2 the pathogenesis involves pulmonary edema, diffuse cellular destruction, alveolar collapse, and disordered repair. Mortality and health care costs are high, 3 and long-term survivors experience serious morbidity. 4 See also pp 646, 691, and 693.

Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study

“…In the present study, the animals remained hemodynamically stable, regardless of the PEEP administered, with all groups showing similar heart rate, perfusion, and lactate levels, data similar to those of the literature (4,7,13).…”

Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single centre cohort study of 20 consecutive patients

“…Patients with lower static compliance had lower baseline PF ratios. Absolute levels of compliance were low and comparable with previous studies in "classic" ARDS [19,20]. Also, we did not observe a reduction in static compliance during prone positioning, as would be expected if lung recruitment did not occur.…”

Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome

“…Our results, in line with previous studies (27), clearly support the concept of an individualized PEEP setting in ARDS, taking into account lung morphology at ZEEP (28). The application of high levels of pressures without considering potential for recruitment could at least in part explain the uncertain results of recent trials testing the impact of high PEEP on outcome in ARDS (29,30).…”