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Mechanical Ventilation in ARDS

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Reducing Mortality in Critically Ill Patients

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Abstract

Lung-protective ventilation (LPV) and prone positioning (PP) are currently the two cornerstones of acute respiratory distress syndrome (ARDS) treatment. LPV with low tidal volumes, moderate-to-high levels of positive end-expiratory pressure (PEEP) and, possibly, recruitment maneuvers has been widely shown in randomized controlled trials (RCTs) to reduce mortality in ARDS patients. However, evidence about the favorable effects in terms of survival of PEEP and recruitment maneuvers is not as conclusive as that about low tidal volumes. PP has been shown for over 40 years to improve oxygenation in ARDS patients but only in recent years a large multicenter RCT succeeded in showing improved survival with this strategy.

In this chapter, we discuss the main evidences about the role of LPV and PP in reducing mortality among ARDS patients, the pathophysiological mechanisms through which these interventions are believed to improve survival, and their use in clinical practice. Moreover, other therapeutic strategies related to mechanical ventilation which have been suggested to possibly affect mortality in ARDS patients, such as different mechanical ventilation modes, high-frequency oscillatory ventilation (HFOV), use of esophageal pressure for PEEP titration, and targeting mechanical ventilation according to driving pressure, are briefly discussed.

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Author information

Authors and Affiliations

  1. Cardiac Anesthesia and Intensive Care Unit, A.O.R.N. “Dei Colli”, Monaldi Hospital, Naples, Italy

    Antonio Pisano & Luigi Verniero

  2. Postgraduate school of Anesthesia and Critical Care, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Rosanna Buonomo

  3. II Anesthesia and Critical Care Unit, A.O.R.N. “Cardarelli”, Naples, Italy

    Teresa P. Iovino

  4. U.O. Anestesia e Rianimazione San Raffaele, IRCCS San Raffaele, Milan, Italy

    Roberta Maj & Federico Masserini

Authors
  1. Antonio Pisano
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  2. Rosanna Buonomo
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  3. Teresa P. Iovino
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  4. Roberta Maj
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  5. Federico Masserini
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  6. Luigi Verniero
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Corresponding author

Correspondence to Antonio Pisano .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy

    Giovanni Landoni

  2. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Martina Baiardo Redaelli

  3. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Chiara Sartini

  4. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy

    Alberto Zangrillo

  5. Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia

    Rinaldo Bellomo

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Pisano, A., Buonomo, R., Iovino, T.P., Maj, R., Masserini, F., Verniero, L. (2021). Mechanical Ventilation in ARDS. In: Landoni, G., Baiardo Redaelli, M., Sartini, C., Zangrillo, A., Bellomo, R. (eds) Reducing Mortality in Critically Ill Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-71917-3_5

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  • DOI: https://doi.org/10.1007/978-3-030-71917-3_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71916-6

  • Online ISBN: 978-3-030-71917-3

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