Critical Care Master Class - At the Edge of the Evidence-What's New in Mechanical Ventilation of Patients With Acute Respiratory Failure Qadir

What's New in Mechanical Ventilation of Patients With Acute Respiratory Failure Qadir

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The document is a presentation on updates in the mechanical ventilation management of patients with Acute Respiratory Distress Syndrome (ARDS), authored by Dr. Nida Qadir. It highlights several key interventions and their effects on mortality and patient outcomes. <br /><br />It stresses that prolonged lung recruitment maneuvers (defined as lasting 60 seconds) are associated with increased mortality in ARDS patients, and are not recommended. Brief maneuvers have uncertain outcomes and may cause hemodynamic instability and barotrauma. Neuromuscular blockers may reduce mortality in early-onset severe ARDS, compared to deep sedation. Corticosteroids are shown to decrease mortality in early ARDS, but if started more than two weeks post-onset, they may cause harm. Inhaled nitric oxide has not shown mortality benefits and could increase renal impairment risks.<br /><br />The document also compares guidelines from different institutions such as the American Thoracic Society (ATS) and the European Society of Intensive Care Medicine (ESICM), which address interventions like tidal volume, positive end-expiratory pressure (PEEP), and extracorporeal membrane oxygenation (ECMO). ATS guidelines suggest using higher PEEP in moderate to severe ARDS without prolonged lung recruitment maneuvers, while ESICM does not make a blanket recommendation for PEEP.<br /><br />Corticosteroid regimens in ARDS are discussed with different dosing strategies depending on trials. For selected patients with severe ARDS, venovenous ECMO has been tentatively recommended, although it's resource-intensive and best suited for centers adhering to trial-organizational standards. <br /><br />Both guidelines mostly align in recommendation against prolonged recruitment maneuvers and highlight the conditional nature of many strategies, emphasizing tailoring treatments to individual patient scenarios.

Keywords

ARDS

mechanical ventilation

lung recruitment

neuromuscular blockers

corticosteroids

inhaled nitric oxide

PEEP

ECMO

ATS guidelines

ESICM guidelines