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Open Access Special Issue

New insights in mechanical ventilation and adjunctive therapies in ARDS

  • Denise Battaglini1,2,*,
  • Patricia Rieken Macedo Rocco3,†
  • Paolo Pelosi1,4,*,†,

1Anesthesia and Intensive Care, San Martino Policlinico Hospital, 16132 Genoa, Italy

2Department of Medicine, University of Barcelona (UB), 08001 Barcelona, Spain

3Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, 21941-902 Rio de Janeiro, Brazil

4Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, M5R 1C1 Genoa, Italy

DOI: 10.22514/sv.2022.035

Submitted: 08 February 2022 Accepted: 23 March 2022

Online publish date: 09 May 2022

(This article belongs to the Special Issue New Insights in Acute Respiratory Distress Syndrome)

*Corresponding Author(s): Denise Battaglini E-mail: battaglini.denise@gmail.com
*Corresponding Author(s): Paolo Pelosi E-mail: ppelosi@hotmail.com

† These authors contributed equally.

Abstract

Patients with acute respiratory distress syndrome (ARDS) often require mechanical ventilation (MV) and may experience high morbidity and mortality. The ventilatory management of ARDS patients has changed over the years to mitigate the risk of ventilator-induced lung injury (VILI) and improve outcomes. Current recommended MV strategies include the use of low tidal volume (VT) at 4–6 mL/kg of predicted body weight (PBW) and plateau pressure (PPLAT ) below 27 cmH2O. Some patients achieve better outcomes with low VT than others, and several strategies have been proposed to individualize VT , including standardization for end-expiratory lung volume or inspiratory capacity. To date, no strategy for individualizing positive-end expiratory pressure (PEEP) based on oxygenation, recruitment, respiratory mechanics, or hemodynamics has proven superior for improving survival. Driving pressure, transpulmonary pressure, and mechanical power have been proposed as markers to quantify risk of VILI and optimize ventilator settings. Several rescue therapies, including neuromuscular blockade, prone positioning, recruitment maneuvers (RMs), vasodilators, and extracorporeal membrane oxygenation (ECMO), may be considered in severe ARDS. New ventilator strategies such as airway pressure release ventilation (APRV) and time-controlled adaptive ventilation (TCAV) have demonstrated potential benefits to reduce VILI, but further studies are required to evaluate their clinical relevance. This review aims to discuss the cornerstones of MV and new insights in ARDS ventilatory management, as well as their rationales, to guide the physician in an individually tailored rather than a fixed, sub-physiological approach. We recommend that MV be individualized based on physiological targets to achieve optimal ventilatory settings for each patient.


Keywords

Mechanical ventilation; ARDS; COVID-19; Mechanical power; APRV


Cite and Share

Denise Battaglini,Patricia Rieken Macedo Rocco,Paolo Pelosi. New insights in mechanical ventilation and adjunctive therapies in ARDS. Signa Vitae. 2022.doi:10.22514/sv.2022.035.

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Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

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