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Customization of an Open-Lung Ventilation Strategy to Treat a Case of Life-Threatening Acute Respiratory Distress Syndrome

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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.

Keywords: ALI; ARDS; PEEP; acute lung injury; acute respiratory distress syndrome; decremental PEEP trial; fraction of inspired oxygen; lung recruitment; optimum PEEP; positive end expiratory pressure; pressure-volume curve

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00867

Affiliations: Sentara Norfolk General Hospital, Sentara Healthcare System, Norfolk, Virginia, USA

Publication date: April 1, 2011

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