[Acute respiratory distress syndrome]

Acute respiratory distress syndrome (ARDS) is a non cardiogenic pulmonary edema that results from several pulmonary or extrapulmonary insults. ARDS respiratory manifestations, in fact, represent the expression of a complex and diffuse inflammatory process involving other organs. Mechanical ventilation is considered to be a cornerstone of treatment. Alterations in respiratory mechanic (decrease in compliance) mainly due to the reduction in non-atelectasis lung volume, are responsible for the high airway pressure observed during mechanical ventilation. Since mechanical ventilation, itself, could promote lung injury, a ventilatory strategy combining both, low volumes to limit distension and positive end expiratory pressure to recruit atelectasis may be beneficial. This hypothesis has been recently confirmed in a study involving more than 800 patients, demonstrating that a simple ventilatory strategy based on recent physiological knowledge may affect ARDS outcome.