From protective ventilation to super-protective ventilation for acute respiratory distress syndrome

Excerpt

For a long time, critical care physicians understood that positive pressure mechanical ventilation was a life-saving strategy in patients with acute respiratory failure, especially in patients with acute respiratory distress syndrome, originally described in 1967 [1]. However, the harmful effects of the traditional use of higher tidal volumes and higher airway pressures were not recognized until more than 30 years later when the beneficial effects of ventilation with a lower tidal volume (6 ml/kg predicted body weight, PBW) and a plateau airway pressure <30 cmH₂O were established in the landmark NHLBI ARDS Network trial in 2000 [2]. Some clinicians and investigators were slow to accept these findings, but subsequent trials and a meta-analysis convincingly confirmed the reduction in mortality by using lung-protective ventilator settings in patients with ARDS [3]. Currently, lung protective ventilation is considered standard of care for ARDS [4‐6]. …