Mechanical Ventilation in ARDS

ABSTRACT

Acute respiratory distress syndrome (ARDS) is a form of hypoxemic respiratory failure, which requires supplemental oxygen delivered by mechanical ventilation, either noninvasively or more commonly by invasive mechanical ventilation. Although not currently meeting the definition for ARDS, these patients may also use heated high-flow nasal cannula and can sometimes avoid invasive mechanical ventilation as a result. The avoidance of worsening acute lung injury using lung-protective ventilation is the first principle of invasive mechanical ventilation in these patients. Conventionally, this involves keeping the plateau pressure below 30 cm H2O by using low tidal volume ventilation, based on ideal body weight. Multiple observational series suggest that targeting a low driving pressure concurrently is also important. The determination of the optimal setting for positive end-expiratory pressure (PEEP) remains controversial. The mode of ventilation utilized may be either volume or pressure limited. It has been suggested that vigorous respiratory efforts can worsen lung injury and are best avoided whenever possible. Modes of ventilation such as airway pressure release ventilation lack evidence to support use and should not be used. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.