Optimal ventilator strategies for trauma-related ARDS

Area of Science:

• Critical Care Medicine
• Pulmonology
• Trauma Surgery

Background:

• Acute respiratory distress syndrome (ARDS) identified in the 1960s, presents significant mortality and morbidity.
• The Berlin Consensus defines ARDS, but its criteria are not fully applicable to trauma-induced ARDS.
• Research into ARDS treatment modalities has spanned decades, yet mortality rates remain high.

Purpose of the Study:

• To systematically review the literature on acute respiratory distress syndrome (ARDS).
• To evaluate the applicability of current ARDS definitions to trauma-related cases.
• To assess the effectiveness of various ventilation strategies in managing ARDS, particularly in trauma patients.

Main Methods:

• A systematic literature review was conducted adhering to Preferred Reporting for Systematic Reviews and Meta Analyses (PRISMA) guidelines.
• Searches were performed on Ovid Medline, Web of Science, and PubMed databases.
• The review encompassed studies published between January 1, 1995, and December 31, 2017.

Main Results:

• The literature search identified 64 relevant papers meeting the inclusion criteria.
• The existing body of research on trauma-related ARDS is relatively limited compared to general ARDS research.
• Low tidal volume ventilation emerged as the benchmark treatment strategy in the reviewed literature.

Conclusions:

• ARDS continues to be associated with a high mortality rate, despite extensive research.
• The Berlin Consensus criteria for ARDS may not be optimal for trauma patients.
• While low tidal volume ventilation is the current standard, further research is needed to confirm the benefits of other strategies like positive end-expiratory pressure and airway pressure release ventilation in trauma-related ARDS.