Critical care clinics
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Critical care clinics · Oct 2021
ReviewAcute Respiratory Distress Syndrome: Ventilator Management and Rescue Therapies.
This review describes the management of mechanical ventilation in patients with acute respiratory distress syndrome, including in those with coronavirus disease 2019. Low tidal volume ventilation with a moderate to high positive end-expiratory pressure remains the foundation of an evidence-based approach. We consider strategies for setting positive end-expiratory pressure levels, the use of recruitment maneuvers, and the potential role of driving pressure. Rescue therapies including prone positioning and extracorporeal membrane oxygenation are also discussed.
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Critical care clinics · Oct 2021
ReviewToward Optimal Acute Respiratory Distress Syndrome Outcomes: Recognizing the Syndrome and Identifying Its Causes.
Acute respiratory distress syndrome is a common condition among critically ill patients, but remains under-recognized and undertreated. Under-recognition may result from confusion over the clinical inclusion criteria, as well as a misunderstanding of the complex relationship between the clinical syndrome, the variable histopathologic patterns, and the myriad clinical disorders that cause acute respiratory distress syndrome. The identification of the clinical syndrome and determination of the causal diagnosis are both required to optimize patient outcomes. Here we review the definition, discuss pitfalls in recognizing acute respiratory distress syndrome and consider an approach to ascertain specific etiologies of acute respiratory distress syndrome.