Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Davide Chiumello, Laurent Brochard, John J Marini, Arthur S Slutsky, Jordi Mancebo, V Marco Ranieri, B Taylor Thompson, Laurent Papazian, Marcus J Schultz, Marcelo Amato, Luciano Gattinoni, Alain Mercat, Antonio Pesenti, Daniel Talmor, Jean-Louis Vincent, Davide Chiumello, Laurent Brochard, John J Marini, Arthur S Slutsky, Jordi Mancebo, V Marco Ranieri, B Taylor Thompson, Laurent Papazian, Marcus J Schultz, Marcelo Amato, Luciano Gattinoni, Alain Mercat, Antonio Pesenti, Daniel Talmor, Jean-Louis Vincent

Abstract

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30-45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS.

Keywords: Esophageal pressure; Extracorporeal membrane oxygenation; Positive end-expiratory pressure; Tidal volume; Ventilator support; Ventilator-induced lung injury; Weaning.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

LB has received research grants and/or equipment for his research laboratory from Maquet (NAVA), Covidien (PAV), Air Liquide (helium, CPR), Fisher Paykel (high flow), General Electric (lung volume; ultrasound) and Philips (sleep). ASS consults for Baxter and Novalung/Xenios; in the past few years, he has consulted for Maquet Critical Care. JM has received personal fees from Faron Pharmaceuticals and grants from Covidien and Maquet, all outside the submitted work. BTT reports personal fees from American Thoracic Society, Asahi Kasei, Alexion, Bristol-Myers Squibb, Boehringer Ingelheim, Davita, Farron, Ferring, Glaxo Smith Kline, Intermune, Ra, Regeneron, Radius, Roche Genentec and UpToDate, all outside the submitted work. AM has received personal fees from Faron Pharmaceuticals, personal fees from AIR Liquide Medical Systems, grants and personal fees from Fisher-Paykel, and grants and personal fees from Covidien, personal fees from Pfizer, all outside the submitted work; in addition, AM has a patent deposited by General Electric. J-LV is Editor-in-Chief of Critical Care. The remaining authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Suggested ventilator support options and adjuvant therapies in patients with acute respiratory distress syndrome (ARDS). ECCO2R extracorporeal carbon dioxide removal, ECMO extracorporeal membrane oxygenation, FiO2 inspired oxygen fraction, PEEP positive end-expiratory pressure, MV mechancial ventilation, PaO2 arterial partial pressure of oxygen, SaO2 arterial oxygen saturation

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