Abstract
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) cause substantial morbidity and mortality despite our improved understanding of lung injury, advancements in the application of lung-protective ventilation, and strategies to prevent ventilator-induced lung injury. Severe refractory hypoxemia may develop in a subset of patients with severe ARDS. We review several approaches referred to as “rescue” therapies for severe hypoxemia, including lung-recruitment maneuvers, ventilation modes, prone positioning, inhaled vasodilator therapy, and the use of extracorporeal membrane oxygenation. Each shows evidence for improving oxygenation, though each has associated risks, and no single therapy has proven superior in the management of severe hypoxemia. Importantly, increased survival with these strategies has not been clearly established.
- acute lung injury
- ALI
- acute respiratory distress syndrome
- ARDS
- refractory hypoxemia
- recruitment maneuvers
- airway pressure release ventilation
- APRV
- high-frequency oscillatory ventilation
- HFOV
- prone positioning
- inhaled vasodilators
- extracorporeal membrane oxygenation
Footnotes
- Correspondence: Stephen R Collins MD, Department of Anesthesiology, University of Virginia School of Medicine, PO Box 800710, Charlottesville VA 22908. E-mail: src2f{at}virginia.edu.
On behalf of the authors, Charles G Durbin Jr MD FAARC, Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, presented a version of this paper at the 26th New Horizons Symposium, “ARDS Update,” at the 56th International Respiratory Congress of the American Association for Respiratory Care, held December 6–9, 2010, in Las Vegas, Nevada.
The authors have disclosed no conflicts of interest.
- Copyright © 2011 by Daedalus Enterprises Inc.