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- W37461213 abstract "Patients with the adult respiratory distress syndrome (ARDS) remain extremely challenging to the intensivist during their intensive care unit (ICU) management and to the anesthesiologist caring for them intraoperatively. Accumulating data from basic science and clinical studies have dramatically changed our understanding of the ways in which mechanical ventilation itself may interact with the acutely injured lung to further impair pulmonary function. This understanding has prompted an evolution in approach to the selection of tidal volume, positive end-expiratory pressure (PEEP), and ventilator mode, with clinical outcome studies now suggesting improved pulmonary function and survival. In addition, several new pharmacologic therapies have offered promise in the management of ARDS. These innovations in care, and perhaps even more importantly the supportive management of critically ill patients, generally appear to be associated with an improved survival of patients with ARDS in recent years.64 Accordingly, this article begins with a definition, classification, and pathophysiologic description of ARDS. We then review the concept of volutrauma in acute lung injury, as well as the animal and clinical investigations suggesting that appropriate ventilator settings can minimize this form of exacerbated lung injury. Next, we review the clinical strategies of permissive hypercapnia, “open lung” ventilation, and prone positioning. Therapies that we believe are best used as salvage therapies in ARDS—high-frequency ventilation, inverse-ratio ventilation, and extracorporeal membrane oxygenation/intravenous oxygenation (ECMO/IVOX) are considered. Potentially coupled to the ventilator approaches to these patients are various pharmacologic therapies, some of which are reviewed. We conclude with a practical bedside approach to these patients, attempting to define state-of-the-art management as well as areas that are most appropriately considered experimental." @default.
- W37461213 created "2016-06-24" @default.
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- W37461213 date "1998-03-01" @default.
- W37461213 modified "2023-10-18" @default.
- W37461213 title "ARDS" @default.
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- W37461213 doi "https://doi.org/10.1016/s0889-8537(05)70012-2" @default.
- W37461213 hasPublicationYear "1998" @default.
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