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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Review

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Authors: Davide Chiumello, Laurent Brochard, John J. Marini, Arthur S. Slutsky, Jordi Mancebo, V. Marco Ranieri, B. Taylor Thompson, Laurent Papazian, Marcus J. Schultz, Marcelo Amato, Luciano Gattinoni, Alain Mercat, Antonio Pesenti, Daniel Talmor, Jean-Louis Vincent

Published in: Critical Care | Issue 1/2017

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Abstract

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30–45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS.
Literature
1.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319–23.CrossRefPubMed
2.
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.PubMed
3.
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800.CrossRefPubMed
4.
Chiumello D, Coppola S, Froio S, Gotti M. What's next after ARDS: long-term outcomes. Respir Care. 2016;61:689–99.CrossRefPubMed
5.
6.
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRef
7.
Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303:865–73.CrossRefPubMed
8.
Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.CrossRefPubMed
9.
Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1170–16.CrossRef
10.
Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.CrossRefPubMed
11.
Fan E, Del SL, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253–63.CrossRefPubMed
12.
Delclaux C, L'Her E, Alberti C, Mancebo J, Abroug F, Conti G, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000;284:2352–60.CrossRefPubMed
13.
Brambilla AM, Aliberti S, Prina E, Nicoli F, Del FM, Nava S, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med. 2014;40:942–9.CrossRefPubMed
14.
Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2016;315:2435–41.CrossRefPubMedPubMedCentral
15.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–96.CrossRefPubMed
16.
Mauri T, Turrini C, Eronia N, Grasselli G, Volta CA, Bellani G, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195:1207–15.CrossRefPubMed
17.
Goligher EC, Slutsky AS. Not just oxygen? Mechanisms of benefit from high-flow nasal cannula in hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195:1128–31.CrossRefPubMed
18.
Agarwal R, Aggarwal AN, Gupta D. Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: a proportion meta-analysis. Respir Care. 2010;55:1653–60.PubMed
19.
Berg KM, Lang GR, Salciccioli JD, Bak E, Cocchi MN, Gautam S, et al. The rapid shallow breathing index as a predictor of failure of noninvasive ventilation for patients with acute respiratory failure. Respir Care. 2012;57:1548–54.CrossRefPubMed
20.
Carteaux G, Millan-Guilarte T, de Prost N, Razazi K, Abid S, Thille AW, et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume. Crit Care Med. 2016;44:282–90.CrossRefPubMed
21.
Kangelaris KN, Ware LB, Wang CY, Janz DR, Zhuo H, Matthay MA, et al. Timing of intubation and clinical outcomes in adults with acute respiratory distress syndrome. Crit Care Med. 2016;44:120–9.CrossRefPubMedPubMedCentral
22.
23.
Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012;185:1307–15.CrossRefPubMedPubMedCentral
24.
Helmerhorst HJ, Schultz MJ, van der Voort PH, de Jonge E, van Westerloo DJ. Bench-to-bedside review: the effects of hyperoxia during critical illness. Crit Care. 2015;19:284.CrossRefPubMedPubMedCentral
25.
Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the Oxygen-ICU randomized clinical trial. JAMA. 2016;316:1583–9.CrossRefPubMed
26.
Crotti S, Mascheroni D, Caironi P, Pelosi P, Ronzoni G, Mondino M, et al. Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med. 2001;164:131–40.CrossRefPubMed
27.
Richard JC, Brochard L, Vandelet P, Breton L, Maggiore SM, Jonson B, et al. Respective effects of end-expiratory and end-inspiratory pressures on alveolar recruitment in acute lung injury. Crit Care Med. 2003;31:89–92.CrossRefPubMed
28.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acuite respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346–55.CrossRefPubMed
29.
Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999;282:54–61.CrossRefPubMed
30.
Chiumello D, Colombo A, Algieri I, Mietto C, Carlesso E, Crimella F, et al. Effect of body mass index in acute respiratory distress syndrome. Br J Anaesth. 2016;116:113–21.CrossRefPubMed
31.
Retamal J, Libuy J, Jimenez M, Delgado M, Besa C, Bugedo G, et al. Preliminary study of ventilation with 4 ml/kg tidal volume in acute respiratory distress syndrome: feasibility and effects on cyclic recruitment–derecruitment and hyperinflation. Crit Care. 2013;17:R16.CrossRefPubMedPubMedCentral
32.
Dembinski R, Hochhausen N, Terbeck S, Uhlig S, Dassow C, Schneider M, et al. Pumpless extracorporeal lung assist for protective mechanical ventilation in experimental lung injury. Crit Care Med. 2007;35:2359–66.CrossRefPubMed
33.
Putensen C, Theuerkauf N, Zinserling J, Wrigge H, Pelosi P. Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med. 2009;151:566–76.CrossRefPubMed
34.
Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis. 1981;123:659–64.PubMed
35.
36.
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
37.
Chiumello D, Algieri I, Grasso S, Terragni P, Pelosi P. Recruitment maneuvers in acute respiratory distress syndrome and during general anesthesia. Minerva Anestesiol. 2016;82:210–20.PubMed
38.
Hodgson C, Goligher EC, Young ME, Keating JL, Holland AE, Romero L, et al. Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation. Cochrane Database Syst Rev. 2016;11:CD006667.PubMed
39.
Brower RG, Morris A, MacIntyre N, Matthay MA, Hayden D, Thompson T, et al. Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med. 2003;31:2592–7.CrossRefPubMed
40.
Borges JB, Okamoto VN, Matos GF, Caramez MP, Arantes PR, Barros F, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174:268–78.CrossRefPubMed
41.
Borges JB, Carvalho CR, Amato MB. Lung recruitment in patients with ARDS. N Engl J Med. 2006;355:319–20.CrossRefPubMed
42.
Gattinoni L, Pelosi P, Crotti S, Valenza F. Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1995;151:1807–14.CrossRefPubMed
43.
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
44.
Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016;42:663–73.CrossRefPubMed
45.
Kacmarek RM, Villar J, Sulemanji D, Montiel R, Ferrando C, Blanco J, et al. Open lung approach for the acute respiratory distress syndrome: a pilot, randomized controlled trial. Crit Care Med. 2016;44:32–42.CrossRefPubMed
46.
Talmor D, Sarge T, Malhotra A, O'Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359:2095–104.CrossRefPubMedPubMedCentral
47.
Goligher EC, Kavanagh BP, Rubenfeld GD, Adhikari NK, Pinto R, Fan E, et al. Oxygenation response to positive end-expiratory pressure predicts mortality in acute respiratory distress syndrome. A secondary analysis of the LOVS and ExPress trials. Am J Respir Crit Care Med. 2014;190:70–6.CrossRefPubMed
48.
Fumagalli JM, Berra L, Zhang C, Pirrone M, Santiago R, Gomes S et al. Transpulmonary pressure describes lung morphology during decremental positive end-expiratory pressure trials in obesity. Am J Respir Crit Care Med. 2017;45:1374–81.
49.
50.
Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189:520–31.CrossRefPubMed
51.
Rittayamai N, Katsios CM, Beloncle F, Friedrich JO, Mancebo J, Brochard L. Pressure-controlled vs volume-controlled ventilation in acute respiratory failure: a physiology-based narrative and systematic review. Chest. 2015;148:340–55.CrossRefPubMed
52.
Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806–13.CrossRefPubMed
53.
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
54.
Meade MO, Young D, Hanna S, Zhou Q, Bachman TE, Bollen C et al. Severity of hypoxemia and effect of high frequency oscillatory ventilation in ARDS. Am J Respir Crit Care Med. 2017. doi:10.​1164/​rccm.​201609-1938OC.
55.
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
56.
Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003;31:2727–33.CrossRefPubMed
57.
Beitler JR, Sands SA, Loring SH, Owens RL, Malhotra A, Spragg RG, et al. Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria. Intensive Care Med. 2016;42:1427–36.CrossRefPubMedPubMedCentral
58.
Guervilly C, Bisbal M, Forel JM, Mechati M, Lehingue S, Bourenne J, et al. Effects of neuromuscular blockers on transpulmonary pressures in moderate to severe acute respiratory distress syndrome. Intensive Care Med. 2017;43:408–18.CrossRefPubMed
59.
Fanelli V, Morita Y, Cappello P, Ghazarian M, Sugumar B, Delsedime L, et al. Neuromuscular blocking agent cisatracurium attenuates lung injury by inhibition of nicotinic acetylcholine receptor-alpha1. Anesthesiology. 2016;124:132–40.CrossRefPubMed
60.
61.
Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7.CrossRefPubMed
62.
Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371:126–34.CrossRefPubMed
63.
Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164:43–9.CrossRefPubMed
64.
Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Lujan M, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41:633–41.CrossRefPubMed
65.
66.
Fanelli V, Ranieri MV, Mancebo J, Moerer O, Quintel M, Morley S, et al. Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome. Crit Care. 2016;20:36.CrossRefPubMedPubMedCentral
67.
Marhong JD, Munshi L, Detsky M, Telesnicki T, Fan E. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Med. 2015;41:994–1003.CrossRefPubMed
68.
Goligher EC, Amato MBP, Slutsky AS. Applying precision medicine to trial design using physiology: extracorporeal CO2 removal for ARDS. Am J Respir Crit Care Med. 2017;196:558–68.
69.
Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. 2015;19:424.CrossRefPubMedPubMedCentral
70.
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–56.CrossRefPubMed
71.
Beduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning outcome according to a new definition. The WIND Study. Am J Respir Crit Care Med. 2017;195:772–83.CrossRefPubMed
72.
Perren A, Brochard L. Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med. 2013;39:1885–95.CrossRefPubMed
73.
Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, et al. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest. 2017;151:166–80.CrossRefPubMed
74.
Costa Leme A, Hajjar LA, Volpe MS, Fukushima JT, De Santis Santiago RR, Osawa EA, et al. Effect of intensive vs moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications: a randomized clinical trial. JAMA. 2017;317:1422–32.CrossRefPubMed
Metadata
Title
Respiratory support in patients with acute respiratory distress syndrome: an expert opinion
Authors
Davide Chiumello
Laurent Brochard
John J. Marini
Arthur S. Slutsky
Jordi Mancebo
V. Marco Ranieri
B. Taylor Thompson
Laurent Papazian
Marcus J. Schultz
Marcelo Amato
Luciano Gattinoni
Alain Mercat
Antonio Pesenti
Daniel Talmor
Jean-Louis Vincent
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1820-0

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