PT  - JOURNAL ARTICLE
ED  - ,
TI  - An approach to ventilation in acute respiratory distress syndrome
DP  - 2000 Aug 01
TA  - Canadian Journal of Surgery
PG  - 263--268
VI  - 43
IP  - 4
4099  - http://canjsurg.ca/content/43/4/263.short
4100  - http://canjsurg.ca/content/43/4/263.full
SO  - CAN J SURG2000 Aug 01; 43
AB  - Appropriate management of patients with acute respiratory distress syndrome (ARDS) represents a challenge for physicians working in the critical care environment. Significant advances have been made in understanding the pathophysiology of ARDS. There is also an increasing appreciation of the role of ventilator-induced lung injury (VILI). VILI is most likely related to several different aspects of ventilator management: barotrauma due to high peak airway pressures, lung overdistension or volutrauma due to high transpulmonary pressures, alveolar membrane damage due to insufficient positive end-expiratory pressure levels and oxygen-related cell toxicity. Various lung protective strategies have been suggested to minimize the damage caused by conventional modes of ventilation. These include the use of pressure- and volume-limited ventilation, the use of the prone position in the management of ARDS, and extracorporeal methods of oxygen delivery and carbon dioxide removal. Although the death rate resulting from ARDS has been declining over the past 10 years, there is no evidence that any specific treatment or change in approach to ventilation is the cause of this improved survival.