Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome(ARDS).Mechanical ventilation(MV)remains the cornerstone of supportive therapy for ARDS.Lung-protective...Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome(ARDS).Mechanical ventilation(MV)remains the cornerstone of supportive therapy for ARDS.Lung-protective MV minimizes the risk of ventilator-induced lung injury(VILI)and improves survival.Several parame-ters contribute to the risk of VILI and require careful setting including tidal volume(V_(T)),plateau pressure(P_(plat)),driving pressure(ΔP),positive end-expiratory pressure(PEEP),and respiratory rate.Measurement of energy and mechanical power allows quantification of the relative contributions of various parameters(V_(T),P_(plat),ΔP,PEEP,respiratory rate,and airflow)for the individualization of MV settings.The use of neuromuscular blocking agents mainly in cases of severe ARDS can improve oxygenation and reduce asynchrony,although they are not known to confer a survival benefit.Rescue respiratory therapies such as prone positioning,inhaled nitric oxide,and extracorporeal support techniques may be adopted in specific situations.Furthermore,respiratory weaning protocols should also be considered.Based on a review of recent clinical trials,we present 10 golden rules for individualized MV in ARDS management.展开更多
基金This work was funded by the Brazilian Council for Scien-tific and Technological Development(COVID-19-CNPq)Rio de Janeiro State Research Foundation(COVID-19-FAPERJ)+2 种基金Fund-ing Authority for Studies and Projects(FINEP)Brazilian Ministry of Science,TechnologyInformation COVID-19 Network(RedeVírus MCTI).
文摘Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome(ARDS).Mechanical ventilation(MV)remains the cornerstone of supportive therapy for ARDS.Lung-protective MV minimizes the risk of ventilator-induced lung injury(VILI)and improves survival.Several parame-ters contribute to the risk of VILI and require careful setting including tidal volume(V_(T)),plateau pressure(P_(plat)),driving pressure(ΔP),positive end-expiratory pressure(PEEP),and respiratory rate.Measurement of energy and mechanical power allows quantification of the relative contributions of various parameters(V_(T),P_(plat),ΔP,PEEP,respiratory rate,and airflow)for the individualization of MV settings.The use of neuromuscular blocking agents mainly in cases of severe ARDS can improve oxygenation and reduce asynchrony,although they are not known to confer a survival benefit.Rescue respiratory therapies such as prone positioning,inhaled nitric oxide,and extracorporeal support techniques may be adopted in specific situations.Furthermore,respiratory weaning protocols should also be considered.Based on a review of recent clinical trials,we present 10 golden rules for individualized MV in ARDS management.
