TY - JOUR
T1 - Evolving concepts in the ventilatory management of acute respiratory distress syndrome
AU - Marini, J. J.
PY - 1996
Y1 - 1996
N2 - With few modifications, a high tidal volume, normoxic, normocapnic ventilation paradigm developed as the standard approach to supporting most critically ill patients. Large tidal volumes, high end-tidal (plateau) alveolar pressures, and low levels of positive end-expiratory pressure are still common in many ICUs during ventilation of acute respiratory distress syndrome (ARDS). A body of scientific literature now suggests that this traditional approach may retard healing of the injured lung. A relatively small but growing number of practitioners are shifting their first priority from optimizing oxygen exchange, oxygen delivery, or respiratory system compliance to ensuring adequate lung protection. This article reviews the basis for concern about traditional ventilatory support in ARDS and develops an approach based on current evidence and newer options for management.
AB - With few modifications, a high tidal volume, normoxic, normocapnic ventilation paradigm developed as the standard approach to supporting most critically ill patients. Large tidal volumes, high end-tidal (plateau) alveolar pressures, and low levels of positive end-expiratory pressure are still common in many ICUs during ventilation of acute respiratory distress syndrome (ARDS). A body of scientific literature now suggests that this traditional approach may retard healing of the injured lung. A relatively small but growing number of practitioners are shifting their first priority from optimizing oxygen exchange, oxygen delivery, or respiratory system compliance to ensuring adequate lung protection. This article reviews the basis for concern about traditional ventilatory support in ARDS and develops an approach based on current evidence and newer options for management.
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U2 - 10.1016/S0272-5231(05)70331-2
DO - 10.1016/S0272-5231(05)70331-2
M3 - Article
C2 - 8875011
AN - SCOPUS:0029840612
SN - 0272-5231
VL - 17
SP - 555
EP - 575
JO - Clinics in Chest Medicine
JF - Clinics in Chest Medicine
IS - 3
ER -