Abstract
Considerable progress has been made recently in the understanding of how best to accomplish safe and effective ventilation of patients with acute lung injury. Mechanical and nonmechanical factors contribute to causation of ventilator-associated lung injury. Intervention timing helps determine the therapeutic efficacy and outcome, and the stage and severity of the disease process may determine the patient's vulnerability as well as an intervention's value. Reducing oxygen consumption and ventilatory demands are key to a successful strategy for respiratory support of acute respiratory distress syndrome. Results from major clinical trials can be understood against the background of the complex physiology of ventilator-induced lung injury.
Highlights
In recent years physicians have learned to care better for their patients with acute respiratory failure
A collective implication of the growing evidence base related to respiratory failure is that reducing oxygen consumption and ventilator demands is a rational point of focus and high priority when attempting to optimize respiratory support for the individual patient
Embedded within the Positive End Expiratory Pressure Setting in Adults with Acute Lung Injury and Acute Respiratory Distress Syndrome (EXPRESS) [33] and Lung Open Ventilation Study (LOVS) [34] trials of high versus low positive end-expiratory pressure (PEEP) are data which indicate lower mortality results using higher PEEP when it is associated with an unchanging plateau pressure and reduced driving pressure, especially in patients with disease of higher severity treated earlier in their disease course
Summary
In recent years physicians have learned to care better for their patients with acute respiratory failure. Advances are the result of improvements in the process and delivery of care to our patients who require respiratory support, and in the avoidance of volume overload [13], unnecessary transfusions [14], and ventilator-associated pneumonia [15], among other potentially iatrogenic interventions.
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