![]() The hallmark pathophysiological mechanisms of ARDS follow a predictable pattern that begins with an initial insult with a subsequent inflammatory response, which leads to endothelial damage and increased pulmonary capillary permeability. ![]() There are many well established and potential etiologies of ARDS (see Figure 2), but around 85–90% are caused by pneumonia, sepsis, aspiration of gastric contents, trauma, or blood transfusion. Patients between the ages of 15 and 19 have a 24% mortality, whereas older patients suffer to a greater degree with mortality rates approaching 60%. ![]() This approximates to 10% of intensive care unit (ICU) patients and 23% of patients on mechanical ventilation. The age-adjusted incidence of ARDS in individuals with PaO 2/FiO 2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio ≤ 300 mmHg is 86 per 100,000 person-years and 64 per 100,000 person-years for individuals with PaO 2/FiO 2 ratio ≤ 200 mmHg. Abbreviations: PaO 2 = arterial partial pressure of oxygen FiO 2 = fraction of inspired oxygen PEEP = positive end expiratory pressure CPAP = continuous positive airway pressure.ĪRDS, in regards to incidence, morbidity, and mortality, is a sinister clinical conundrum-a condition that is both common and devastating. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS.īerlin Diagnostic Criteria. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO 2 (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field.
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