Fundamentos de la ventilación mecánica en el síndrome de distrés respiratorio agudo [The basics on mechanical ventilation support in acute respiratory distress syndrome]
2010 (English)In: Medicina Intensiva, ISSN 0210-5691, E-ISSN 1578-6749, Vol. 34, no 6, 418-427 p.Article, review/survey (Refereed) Published
Acute Respiratory Distress Syndrome (ARDS) is understood as an inflammation-induced disruption of the alveolar endothelial-epithelial barrier that results in increased permeability and surfactant dysfunction followed by alveolar flooding and collapse. ARDS management relies on mechanical ventilation. The current challenge is to determine the optimal ventilatory strategies that minimize ventilator-induced lung injury (VILI) while providing a reasonable gas exchange. The data support that a tidal volume between 6-8 ml/kg of predicted body weight providing a plateau pressure <30 cmH(2)O should be used. High positive end expiratory pressure (PEEP) has not reduced mortality, nevertheless secondary endpoints are improved. The rationale used for high PEEP argues that it prevents cyclic opening and closing of airspaces, probably the major culprit of development of VILI. Chest computed tomography has contributed to our understanding of anatomic-functional distribution patterns in ARDS. Electric impedance tomography is a technique that is radiation-free, but still under development, that allows dynamic monitoring of ventilation distribution at bedside.
Place, publisher, year, edition, pages
2010. Vol. 34, no 6, 418-427 p.
Acute respiratory distress syndrome, Mechanical ventilation, Computed tomography scan, Ventilator-induced lung injury, Lung collapse
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-137711DOI: 10.1016/j.medin.2009.10.005ISI: 000281192400007OAI: oai:DiVA.org:uu-137711DiVA: diva2:379000