Future direction of ventilatory strategies in acute respiratory distress syndrome

Abstract

The mechanisms of lung injury in acute respiratory distress syndrome (ARDS) are (1) ventilator-associated lung injury (VALI), in which mechanical ventilation itself causes lung injury, and (2) effort-dependent lung injury, in which vigorous spontaneous effort by the patient causes lung injury. To prevent VALI, lung-protective ventilation strategies have been used, including use of low tidal volumes, low plateau pressures, and positive end-expiratory pressure(PEEP). However, mortality in ARDS has not improved over the past 20 years. To improve the clinical outcomes of patients with ARDS, ventilatory management in ARDS needs to be tailored to patients by identifying subgroups that respond to specific interventions.