Abstract
In the present issue of Critical Care, Frank and Matthay review the physiologic mechanisms that lead to ventilator-induced lung injury. Our greater understanding of basic physiologic principles has already had a major impact on the treatment of critically ill patients. Novel strategies to limit ventilator-induced lung injury have now been shown to improve survival. However, there has been debate in the literature regarding the safety and efficacy of the Acute Respiratory Distress Syndrome (ARDS) Network study protocol in reducing ventilator-induced lung injury. The issues surrounding the ARDS Network protocol and a recent meta-analysis criticizing its use are presented. As clinicians, we now have the responsibility to ensure that our patients benefit from these recent developments.
Highlights
Management of patients with adult respiratory distress syndrome (ARDS) has been a therapeutic challenge for years
In 2000 a large trial funded by the US National Institutes of Health (NIH) [1] demonstrated a 9% reduction in absolute mortality in patients ventilated with a low tidal volume strategy (6 ml/kg versus 12 ml/kg)
The ARDS Network protocol was complex, and differences in management between the experimental and control groups were not limited to changes in the volume of tidal breaths or in plateau pressures
Summary
Management of patients with adult respiratory distress syndrome (ARDS) has been a therapeutic challenge for years. Keywords acute respiratory distress syndrome, ARDS Network, lung injury, lung protective strategy, mechanical ventilation In 2000 a large trial funded by the US National Institutes of Health (NIH) [1] demonstrated a 9% reduction in absolute mortality in patients ventilated with a low tidal volume strategy (6 ml/kg versus 12 ml/kg).
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