Acute respiratory distress syndrome: is the concept of protective ventilation and driving pressure the real future?

Abstract

Since the original description of acute respiratory distress syndrome was made 50 years ago, much has been learned regarding the pathology and pathophysiology of the clinical syndrome. However, no pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and management remains supportive with lung-protective mechanical ventilation. Controlled mechanical ventilation of patients with acute respiratory distress syndrome (ARDS) may contribute to morbidity and mortality by causing ventilator-induced lung injury (VILI). As well mechanical ventilation is critical for survival for many ARDS patients, numerous efforts over the past 50 years have been directed towards minimizing lung injury during mechanical ventilation. Lung-protective ventilation strategy suggests the use of low tidal volume, depending on ideal body weight, limited plateau pressure, and adequate levels of PEEP. We can’t always prevent overstress and overstrain by reducing tidal volume according to ideal body weight. On the con- trary, titrating mechanical ventilation on airway driving pressure, should better reflect lung injury.