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[Invasive mechanical ventilation: indications and alternatives : Systematic evaluation of the evidence and recommendations for clinical practice from the S3 guidelines "invasive mechanical ventilation and the use of extracorporeal procedures in acute respiratory failure"].

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[ARDS - An Update - Part 2: Therapy and Outcome].

Rolf Dembinski, Frank Mielck

    Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
    |February 10, 2018
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    Acute Respiratory Distress Syndrome (ARDS) management remains challenging, particularly mechanical ventilation settings like positive end-expiratory pressure. Research continues to explore optimal strategies for gas exchange while minimizing lung injury and addressing long-term survivor mental health.

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    Area of Science:

    • Pulmonary Medicine
    • Critical Care Medicine
    • Respiratory Physiology

    Background:

    • Acute Respiratory Distress Syndrome (ARDS) is a severe hypoxemic respiratory failure driven by lung inflammation.
    • Despite extensive research, optimal mechanical ventilation strategies for ARDS remain a significant clinical challenge.
    • Current adjunctive therapies include prone positioning and fluid management, with no specific pharmacological treatments proven effective.

    Observation:

    • Mechanical ventilation in ARDS presents a dichotomy: improving gas exchange versus causing ventilator-associated lung injury.
    • Key areas of ongoing debate include the optimal settings for positive end-expiratory pressure (PEEP) and the impact of spontaneous breathing.
    • Long-term follow-up of ARDS survivors frequently reveals significant anxiety and mental health disorders.

    Findings:

    • The precise adjustment of mechanical ventilation parameters in ARDS is complex, balancing therapeutic benefits against iatrogenic harm.
    • Controversies persist regarding the ideal positive end-expiratory pressure (PEEP) levels and the significance of spontaneous breathing activity during ventilation.
    • No pharmacological interventions have demonstrated efficacy in treating ARDS to date.

    Implications:

    • Further research is crucial to refine mechanical ventilation protocols, aiming to maximize pulmonary gas exchange while minimizing lung injury.
    • Investigating the long-term psychological sequelae of ARDS is essential for comprehensive patient care and recovery.
    • Developing targeted therapies for ARDS and understanding the mechanisms of ventilator-induced lung injury remain critical research priorities.