RT Journal Article
SR Electronic
T1 Customization of an Open-Lung Ventilation Strategy to Treat a Case of Life-Threatening Acute Respiratory Distress Syndrome
JF Respiratory Care
FD American Association for Respiratory Care
SP 514
OP 519
DO 10.4187/respcare.00867
VO 56
IS 4
A1 David A Grooms
A1 Stephen H Sibole
A1 James R Tomlinson
A1 Paul E Marik
A1 Robert L Chatburn
YR 2011
UL http://rc.rcjournal.com/content/56/4/514.abstract
AB The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and FIO2 table, and managing alveolar end-inspiratory pressure by limiting the plateau airway pressure to ≤ 30 cm H2O. Although this strategy, to date, is the only method that significantly improves ALI/ARDS survival, alternative methods of improving hypoxemia and minimizing ventilator-induced lung injury, in conjunction with low-tidal-volume ventilation, can be used for life-threatening ARDS. We present a case in which we customized the use of alveolar recruitment maneuvers by analyzing the hysteresis of the pressure-volume curve to assess lung recruitability, decremental PEEP to sustain lung recruitment, and careful use of plateau pressure ≥ 30 cm H2O, which improved our patient's life-threatening hypoxemia within the first 36 min of arrival to our ICU.