Optimal lung-protective ventilation strategy in 2017

Maureen Meade

What is the optimal lung-protective ventilation strategy in 2017?

Maureen Meade: That is a very good question because there has been a major undertaking for the past couple of years put together: international evidence-based guidelines for the management of acute respiratory distress syndrome (ARDS). I would say that the one intervention that was most strongly recommended by this panel is prone ventilation for patients who have quite severe acute lung injury or ARDS. That is a strong recommendation. We use that for people who have quite severe lung injury.

Other key intervention is lung-protective ventilation with respect to low tidal volumes. It has also been shown to improve survival for people with acute lung injury. The recommendation there was quite strong.

The other intervention that the evidence is not quite as clear on: next to prone ventilation and low-tidal-volume ventilation, an open lung strategy that utilizes relatively high levels of positive end-expiratory pressure is probably beneficial for our patients.

What we also have learned recently is that such interventions that at times have been very promising for the management of these very critically ill patients in the intensive care unit, interventions that were shown to or expected to be very helpful, have proven to be unhelpful and probably increased death rates rather than increasing survival. Most notably, those are inhaled nitric oxide therapy and high-frequency oscillation. There are some patients for whom we might rely upon those interventions when acute lung injury is extremely life-threatening and oxygenation is extremely compromised, but for the most part, we should be avoiding those interventions that we thought would be useful in the past.

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