Do we need mechanical ventilation to treat acute respiratory distress syndrom in the future

Abstract

Acute respiratory distress syndrome (ARDS) is one of the most severe type of acute respiratory failure. Mechanical ventilation (MV) is the cornerstone therapy for ARDS patients, for its important effects on improving oxygenation and carbon dioxide (CO2) excretion, and also for its supporting effects for other organs in critically ill patients. However, with invasive MV being widely applied, its potential harm was also recognized, especially for ventilator-induced lung injury (VILI). In the past few years, there has been a consistent effort to develop alternative strategies to completely avoid the need for invasive MV. In particular, several studies have explored the feasibility and efficacy of non-invasive MV、high flow nasal cannula oxygen therapy、extracorporeal oxygenation、carbon dioxide removal and some pharmacological therapies and so on. As ARDS is a heterogeneous disease , therapeutic methods instead of invasive MV might be effective for some patients in some clinical sinario during some stage of ARDS. But still, invasive MV remains the mainstay of care for most of the patients with ARDS. Key words: Acute respiratory distress syndrome; Mechanical ventilation; Lung protective ventilation; Ventilator-induced lung injury