Expert review of respiratory medicine
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Expert Rev Respir Med · Feb 2008
Current ventilatory management of patients with acute lung injury/acute respiratory distress syndrome.
The current main objective of mechanical ventilation during acute respiratory distress syndrome (ARDS) is to improve oxygenation while preventing ventilator-induced lung injury (VILI) in order to save a patient's life. The major determinants of VILI are both hyperinflation of normally aerated lung and repetitive opening and closing of lung units. There are two methods of preventing VILI and, hence, making mechanical ventilation lung protective. ⋯ This strategy requires alveolar pressures much larger than 30 cm H(2)O transiently to overcome the critical opening pressures of the lung. One drawback is hemodynamic impairment. To date, this strategy has not been found to be associated with an improvement of patient outcome.
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Expert Rev Respir Med · Feb 2008
Noninvasive positive pressure ventilation for patients with acute hypoxemic respiratory failure?
The re-emergence of noninvasive positive pressure ventilation (NIV) represents perhaps the single greatest advance in mechanical ventilation over the last 20 years. Clear benefit has been demonstrated for patients with respiratory failure in the setting of acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema. ⋯ Presently, there is little evidence to support the use of NIV for patients presenting with hypoxemic respiratory failure who fulfill the American and European Consensus Conference definition of acute lung injury or acute respiratory distress syndrome, other than in patients with high risk for death if endotracheally intubated (immunocompromised patients, postlung resection acute respiratory distress syndrome). As there are reasonable rationales for both benefit and harm, there is a need for a large, multicenter, randomized, controlled trial to clarify whether NIV offers benefit in terms of a reduced need for endotracheal intubation, length of stay and hospital mortality.