Evolving concepts in the ventilatory management of acute respiratory distress syndrome

J. J. Marini

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)555-575
Number of pages21
JournalClinics in Chest Medicine
Issue number3
StatePublished - 1996
Externally publishedYes


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