Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome.
Chieh-Jen WangI-Ting WangChao-Hsien ChenYen-Hsiang TangHsin-Wei LinChang-Yi LinChien-Liang WuPublished in: Journal of personalized medicine (2024)
Even though much progress has been made to improve clinical outcomes, acute respiratory distress syndrome (ARDS) remains a significant cause of acute respiratory failure. Protective mechanical ventilation is the backbone of supportive care for these patients; however, there are still many unresolved issues in its setting. The primary goal of mechanical ventilation is to improve oxygenation and ventilation. The use of positive pressure, especially positive end-expiratory pressure (PEEP), is mandatory in this approach. However, PEEP is a double-edged sword. How to safely set positive end-inspiratory pressure has long been elusive to clinicians. We hereby propose a pressure-volume curve measurement-based method to assess whether injured lungs are recruitable in order to set an appropriate PEEP. For the most severe form of ARDS, extracorporeal membrane oxygenation (ECMO) is considered as the salvage therapy. However, the high level of medical resources required and associated complications make its use in patients with severe ARDS controversial. Our proposed protocol also attempts to propose how to improve patient outcomes by balancing the possible overuse of resources with minimizing patient harm due to dangerous ventilator settings. A recruitment-potential-oriented evaluation-based protocol can effectively stabilize hypoxemic conditions quickly and screen out truly serious patients.
Keyphrases
- mechanical ventilation
- acute respiratory distress syndrome
- respiratory failure
- extracorporeal membrane oxygenation
- intensive care unit
- end stage renal disease
- newly diagnosed
- ejection fraction
- randomized controlled trial
- chronic kidney disease
- healthcare
- prognostic factors
- palliative care
- peritoneal dialysis
- high throughput
- patient reported outcomes
- risk factors
- patient reported
- climate change
- mesenchymal stem cells
- risk assessment
- drug induced
- quality improvement
- human health
- single cell