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Lung-Protective Ventilation and Mortality in Acute Respiratory Distress Syndrome

  • Chapter
Reducing Mortality in Critically Ill Patients

Abstract

Lung-protective ventilation involves the use of low tidal volumes, moderate-to-high levels of positive end expiratory pressure and, sometimes, recruitment maneuvers (i.e. a transitory increase in transpulmonary pressure aimed at opening atelectatic alveoli). It may prevent or attenuate ventilator induced lung injury and has been widely shown to reduce mortality in patients with acute respiratory distress syndrome. Lung-protective ventilation is, actually, one of the interventions best proven to have an impact on mortality in critically ill patients. In fact, three multicenter randomized controlled trials found that ventilation with low tidal volumes, with or without high positive end expiratory pressure, improves survival in patients with acute respiratory distress syndrome. However, two recent meta-analyses failed to demonstrate a survival benefit of high positive end expiratory pressure. Therefore, evidence about high positive end expiratory pressure is not as conclusive as that about low tidal volumes and further trials are needed in order to define “best” positive end expiratory pressure.

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Authors and Affiliations

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

    Antonio Pisano MD & Teresa P. Iovino MD

  2. Faculty of Medical Sciences, Vita-salute San Raffaele University, Milan, Italy

    Roberta Maj

Authors
  1. Antonio Pisano MD
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  2. Teresa P. Iovino MD
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  3. Roberta Maj
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Corresponding author

Correspondence to Antonio Pisano MD .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Intensive care, IRCCS San Raffaele Scientifi c Institute, Milan, Milano, Italy

    Giovanni Landoni

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

    Marta Mucchetti

  3. San Raffaele Hospital, Milan, Italy

    Alberto Zangrillo

  4. Department of Intensive Care, Austin Hospital, Heidelberg, Vic. 3084, Australia

    Rinaldo Bellomo

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Pisano, A., Iovino, T.P., Maj, R. (2015). Lung-Protective Ventilation and Mortality in Acute Respiratory Distress Syndrome. In: Landoni, G., Mucchetti, M., Zangrillo, A., Bellomo, R. (eds) Reducing Mortality in Critically Ill Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-17515-7_3

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  • DOI: https://doi.org/10.1007/978-3-319-17515-7_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17514-0

  • Online ISBN: 978-3-319-17515-7

  • eBook Packages: MedicineMedicine (R0)

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