Lung Recruitability in Early ARDS
Lung Recruitment in ARDS
The symptoms of acute respiratory distress syndrome (ARDS) include cyanosis refractory to oxygen therapy, lower lung compliance, radiographic evidence of diffuse bilateral infiltrates, and PaO2/FiO2 ? 200 mmHg (reviewed by LaFollette, Norton, DiRocco, Carney, and Nieman, 2006). Problems arise when normal tidal volumes are used to ventilate ARDS lungs, because much of the lung tissue is refractory to recruitment. As a result, ventilator-induced lung injury (VILI) occurs due to lung distention. Mechanical ventilation of patients with ARDS therefore is associated with a high rate of mortality.
Awareness of the association between a poor prognosis and mechanical ventilation in ARDS is several decades old, yet considerable controversy remains concerning the optimal treatment approach (reviewed by de Matos et al., 2012). There is some consensus that positive end-expiratory pressure (PEEP) should be titrated during recruitment maneuvers, to minimize lung distention. Some clinicians have even argued for the efficacy of the so-called 'open-lung hypothesis', which states that collapsed lung tissue in early ARDS can be reclaimed with acceptable clinical costs. To date this hypothesis has received no empirical support, primarily...
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