Colesterol e cardiopatias

Mechanical Ventilation in ARDS*
A State-of-the-Art Review
Timothy D. Girard, MD; and Gordon R. Bernard, MD, FCCP
Mechanical ventilation is an essential component of the care of patients with ARDS, and a large number of randomized controlled clinical trials have now been conducted evaluating the efficacy and safety of various methods of mechanical ventilation for the treatment of ARDS. Low tidal volume ventilation (< 6 mL/kg predicted body weight) should be utilized in all patients with
ARDS as it is the only method of mechanical ventilation that, to date, has been shown to improve survival. High positive end-expiratory pressure, alveolar recruitment maneuvers, and prone positioning may each be useful as rescue therapy in a patient with severe hypoxemia, but these methods of ventilation do not improve survival for the wide population of patients with ARDS.
Although not specific to the treatment of ARDS, protocol-driven weaning that utilizes a daily spontaneous breathing trial and ventilation in the semirecumbent position have proven benefits and should be used in the management of ARDS patients. (CHEST 2007; 131:921–929)
Key words: acute lung injury; ARDS; mechanical ventilation; positive end-expiratory pressure; prone position; tidal volumes Abbreviations: ALI
acute lung injury; ALVEOLI
Assessment of Low Tidal Volume and Elevated End-Expiratory
Pressure To Obviate Lung Injury; APACHE
acute physiology and chronic health evaluation; APRV
airway pressure release ventilation; ARMA
Respiratory Management in Acute Lung Injury/Acute Respiratory Distress Syndrome;
CI
confidence interval; Fio2
fraction of inspired oxygen; IL
interleukin; IRV
inverse ratio ventilation;
PEEP
positive end-expiratory pressure; Pflex
lower inflection point on the pressure-volume curve of the respiratory system
Prior to the development and widespread use of positive-pressure ventilators, acute lung injury
(ALI) and ARDS, often termed double pneumonia,