Evidence-based interventions in ARDS

Dr Brian Garibaldi is an associate professor in the Division of Pulmonary and Critical Care Medicine and director of the Biocontainment Unit at Johns Hopkins Medicine (USA).

What interventions for the treatment of acute respiratory distress syndrome (ARDS) are evidence based?

Brian Garibaldi, MD: Probably the best studied intervention—something that came out of the ARDS Network and was pioneered by one of my mentors, Roy Brower, at Johns Hopkins Medicine—is the use of low tidal volume ventilation to try to minimize the risk of ventilator-associated lung injury.

That article came out over a decade ago. It has taken a while for this intervention to be used widely in practice because in reality it can be very difficult to effectively manage somebody with low tidal volume ventilation, as they might have air hunger or problems with hypercapnia. But we know that this improves mortality and has become the standard of care for ARDS.

That is probably the only, or the best, evidence that we have to reduce mortality in that particular condition.

For a mobile educational application for health-care professionals in charge of patients on mechanical ventilation, go to www.opencriticalcare.org.