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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Viewpoint

How ARDS should be treated

Authors: Luciano Gattinoni, Michael Quintel

Published in: Critical Care | Issue 1/2016

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Abstract

The Berlin definition criteria applied at positive end-expiratory pressure (PEEP) 5 cm H2O reasonably predict lung edema and recruitabilty. To maintain viable gas exchange, the mechanical ventilation becomes progressively more risky going from mild to severe acute respiratory distress syndrome (ARDS). Tidal volume, driving pressure, flow, and respiratory rate have been identified as causes of ventilation-induced lung injury. Taken together, they represent the mechanical power applied to the lung parenchyma. In an inhomogeneous lung, stress risers locally increase the applied mechanical power. Increasing lung homogeneity by PEEP and prone position decreases the harm of mechanical ventilation, particularly in severe ARDS.
Literature
1.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319–23.CrossRefPubMed
2.
Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L. Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:8–13.CrossRefPubMed
3.
Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology. 1988;69:824–32.CrossRefPubMed
4.
Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M. Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis. 1987;136:730–6.CrossRefPubMed
5.
Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ. 2008;336:1006–9.CrossRefPubMedPubMedCentral
6.
McAuley DF, Laffey JG, O’Kane CM, Perkins GD, Mullan B, Trinder TJ, et al. Simvastatin in the acute respiratory distress syndrome. N Engl J Med. 2014;371:1695–703.CrossRefPubMed
7.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.
8.
Gattinoni L, Carlesso E, Brazzi L, Cressoni M, Rosseau S, Kluge S, et al. Friday night ventilation: a safety starting tool kit for mechanically ventilated patients. Minerva Anestesiol. 2014;80:1046–57.PubMed
9.
Patroniti N, Bellani G, Maggioni E, Manfio A, Marcora B, Pesenti A. Measurement of pulmonary edema in patients with acute respiratory distress syndrome. Crit Care Med. 2005;33:2547–54.CrossRefPubMed
10.
Trepte CJ, Phillips CR, Solà J, Adler A, Haas SA, Rapin M, et al. Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury. Crit Care Lond Engl. 2016;20:18.CrossRef
11.
Godje O, Peyerl M, Seebauer T, Dewald O, Reichart B. Reproducibility of double indicator dilution measurements of intrathoracic blood volume compartments, extravascular lung water, and liver function. Chest. 1998;113:1070–7.CrossRefPubMed
12.
Caironi P, Carlesso E, Cressoni M, Chiumello D, Moerer O, Chiurazzi C, et al. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study. Crit Care Med. 2015;43:781–90.CrossRefPubMed
13.
Pelosi P, Goldner M, McKibben A, Adams A, Eccher G, Caironi P, et al. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med. 2001;164:122–30.CrossRefPubMed
14.
Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA J Am Med Assoc. 1993;269:2122–7.CrossRef
15.
Cressoni M, Chiumello D, Carlesso E, Chiurazzi C, Amini M, Brioni M, et al. Compressive forces and computed tomography-derived positive end-expiratory pressure in acute respiratory distress syndrome. Anesthesiology. 2014;121:572–81.CrossRefPubMed
16.
Kallet RH, Hemphill JC, Dicker RA, Alonso JA, Campbell AR, Mackersie RC, et al. The spontaneous breathing pattern and work of breathing of patients with acute respiratory distress syndrome and acute lung injury. Respir Care. 2007;52:989–95.PubMed
17.
Langer T, Vecchi V, Belenkiy SM, Cannon JW, Chung KK, Cancio LC, et al. Extracorporeal gas exchange and spontaneous breathing for the treatment of acute respiratory distress syndrome: an alternative to mechanical ventilation? Crit Care Med. 2014;42:e211–20.CrossRefPubMed
18.
Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet J-F, Eisner MD, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med. 2002;346:1281–6.CrossRefPubMed
19.
Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med. 1990;16:372–7.CrossRefPubMed
20.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346–55.CrossRefPubMed
21.
Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med. 1994;149:1327–34.CrossRefPubMed
22.
Caironi P, Cressoni M, Chiumello D, Ranieri M, Quintel M, Russo SG, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181:578–86.CrossRefPubMed
23.
Jiang D, Liang J, Fan J, Yu S, Chen S, Luo Y, et al. Regulation of lung injury and repair by Toll-like receptors and hyaluronan. Nat Med. 2005;11:1173–9.CrossRefPubMed
24.
Mascheroni D, Kolobow T, Fumagalli R, Moretti MP, Chen V, Buckhold D. Acute respiratory failure following pharmacologically induced hyperventilation: an experimental animal study. Intensive Care Med. 1988;15:8–14.CrossRefPubMed
25.
Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157:294–323.CrossRefPubMed
26.
Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–55.CrossRefPubMed
27.
Hotchkiss JR, Blanch L, Murias G, Adams AB, Olson DA, Wangensteen OD, et al. Effects of decreased respiratory frequency on ventilator-induced lung injury. Am J Respir Crit Care Med. 2000;161(2 Pt 1):463–8.CrossRefPubMed
28.
Fujita Y, Fujino Y, Uchiyama A, Mashimo T, Nishimura M. High peak inspiratory flow can aggravate ventilator-induced lung injury in rabbits. Med Sci Monit Int Med J Exp Clin Res. 2007;13:BR95–100.
29.
Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology. 2016 Feb 12. [Epub ahead of print].
30.
Protti A, Andreis DT, Milesi M, Iapichino GE, Monti M, Comini B, et al. Lung anatomy, energy load, and ventilator-induced lung injury. Intensive Care Med Exp. 2015;3:34.CrossRefPubMedPubMedCentral
31.
Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970;28:596–608.PubMed
32.
Cressoni M, Cadringher P, Chiurazzi C, Amini M, Gallazzi E, Marino A, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2014;189:149–58.PubMed
33.
Cressoni M, Chiurazzi C, Gotti M, Amini M, Brioni M, Algieri I, et al. Lung inhomogeneities and time course of ventilator-induced mechanical injuries. Anesthesiology. 2015;123:618–27.CrossRefPubMed
34.
Rich PB, Reickert CA, Sawada S, Awad SS, Lynch WR, Johnson KJ, et al. Effect of rate and inspiratory flow on ventilator-induced lung injury. J Trauma. 2000;49:903–11.CrossRefPubMed
35.
Protti A, Andreis DT, Monti M, Santini A, Sparacino CC, Langer T, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med. 2013;41:1046–55.CrossRefPubMed
36.
Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795–805.CrossRefPubMed
37.
Marini JJ. Does high-pressure, high-frequency oscillation shake the foundations of lung protection? Intensive Care Med. 2015;41:2210–2.CrossRefPubMed
38.
Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med. 2013;188:1286–93.CrossRefPubMed
39.
Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38:1573–82.CrossRefPubMed
40.
Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354:1775–86.CrossRefPubMed
Metadata
Title
How ARDS should be treated
Authors
Luciano Gattinoni
Michael Quintel
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1268-7

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