Mechanical ventilation in the acute respiratory distress syndrome - 2006

Given the joint potential for the ventilator to offer life support or extend the severity and duration of the illness, the machine settings for the ventilatory cycle are of unquestioned importance. How best to achieve the appropriate tradeoff, however, remains a topic of active debate. The currently available clinical database appears compatible with the highly consistent scientific body of information that addresses ventilator usage in the setting of acute lung injury. Unfortunately, most efforts to conduct clinical trials to inform clinical practice have been severely hampered, however, by imprecise definitions and protocols that lack mechanistic sophistication. In this paper, clinical trials of lung protection are reviewed and the insights gained are used to propose general guidelines for ventilatory management as well as a suggested management sequence for patients with the acute respiratory distress syndrome.