First Stabilize and then Gradually Recruit: A Paradigm Shift in Protective Mechanical Ventilation for Acute Lung...

Area of Science:

• Mechanical Ventilation
• Respiratory Physiology
• Critical Care Medicine

Background:

• Acute respiratory distress syndrome (ARDS) involves heterogeneous lung injury, leading to atelectasis and repetitive alveolar collapse and expansion (RACE).
• Existing protective lung strategies (PLA, OLA) have limitations in addressing regional alveolar instability.
• Recent understanding highlights regional alveolar instability as a key mechanism of ventilator-induced lung injury (VILI).

Purpose of the Study:

• To propose and describe a novel 'stabilize lung approach' (SLA) for ventilating ARDS lungs.
• To introduce time-controlled adaptive ventilation (TCAV) as the core method for implementing SLA.
• To contrast SLA with previous ventilation strategies like the open lung approach (OLA).

Main Methods:

• SLA utilizes time-controlled adaptive ventilation (TCAV), adjusting airway pressure release ventilation (APRV) parameters.
• TCAV features a very brief exhalation time (≤0.5 s) to prevent alveolar collapse.
• It incorporates an inflate and brake ratchet with extended inspiratory duration (4-6 s) for gradual recruitment.

Main Results:

• SLA aims to immediately stabilize lung tissue and reduce RACE.
• The method gradually reopens collapsed lung tissue over hours to days.
• Translational animal studies, clinical analysis, and case reports support TCAV's efficacy in lung protection.

Conclusions:

• The stabilize lung approach (SLA) offers a novel strategy for ARDS ventilation.
• TCAV, the core of SLA, effectively reduces repetitive alveolar collapse and expansion.
• SLA demonstrates potential as an efficacious lung protective strategy in ARDS.