Ventilator-associated lung injury may be an important cause of poor clinical outcomes in patients with acute respiratory distress syndrome (ARDS). As a result, strategies of mechanical ventilation that reduce the incidence and severity of ventilator-associated lung injury are being sought. The mechanical ventilatory strategies known as low tidal volume ventilation, open lung ventilation, and high positive end-expiratory pressure (high PEEP) are reviewed here. In addition, recruitment maneuvers and titration of PEEP are described.
The Berlin Definition of ARDS (published in 2012) has replaced the American-European Consensus Conference’s definition of ARDS (published in 1994) [1,2]. However, it should be recognized that most evidence is based upon prior definitions. The current diagnostic criteria for ARDS are provided separately. (See "Acute respiratory distress syndrome: Clinical features and diagnosis", section on 'Diagnostic criteria'.)
Epidemiology, etiology, pathogenesis, clinical features, diagnosis, prognosis, outcomes, and non-mechanical ventilation related aspects of management are discussed separately. (See "Acute respiratory distress syndrome: Clinical features and diagnosis" and "Acute respiratory distress syndrome: Epidemiology; pathophysiology; pathology; and etiology" and "Supportive care and oxygenation in acute respiratory distress syndrome" and "Novel therapies for the acute respiratory distress syndrome" and "Acute respiratory distress syndrome: Prognosis and outcomes".)
LOW TIDAL VOLUME VENTILATION
Low tidal volume ventilation (LTVV) is also referred to as lung protective ventilation. The rationale for this approach is that smaller tidal volumes are less likely to generate alveolar overdistension, one of the principal causes of ventilator-associated lung injury. (See "Ventilator-associated lung injury", section on 'Pathogenesis'.)
Benefit — The preponderance of evidence suggests that LTVV improves mortality, as well as other clinically important outcomes in patients with ARDS [3-5]: