Management of acute respiratory distress syndrome

Abstract

Background: Managing patients with acute respiratory distress syndrome (ARDS) still remains a challenge to the intensivists despite huge accumulation of basic and clinical data and better understanding in its management. The evolution of the concept of ventilator associated lung injury (VALI) in mechanically ventilated patients with ARDS has changed the approach to ventilatory management. Survival of the patients with ARDS may be improved by modifying the mechanical ventilation such that VALI is kept to a minimum. Protective strategy in mechanical ventilation with limited volume and pressure is the only accepted treatment or supportive measure shown to affect the outcome in ARDS patients. Low tidal volume ventilation has been recommended for every patient with ARDS to be used routinely. Protective ventilatory strategy has been accepted as a new gold standard and is being used to evaluate and compare other techniques and modalities. Use of approaches such as prone position ventilation, inhaled nitric oxide and surfactant has failed to improve survival in clinical studies. But these approaches may confer benefits if used in conjunction with the protective strategy.