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Organ-specific support in multiple organ failure: pulmonary support
1Department of Surgery, Cornell University Medical College, New York 10021, USA.
World Journal of Surgery
|July 1, 1995
Summary
Acute Respiratory Distress Syndrome (ARDS) is a complex lung failure in trauma and sepsis. Management involves optimizing ventilation, fluid balance, and addressing infections, with nitric oxide showing potential therapeutic benefits.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Trauma Surgery
Background:
- Catastrophic pulmonary failure is a recognized complication in patients with multiple trauma or sepsis with shock.
- Acute Respiratory Distress Syndrome (ARDS) presentation is variable, with heterogeneous lung injury distribution and not all patients developing ARDS after major insults.
- ARDS can be conceptualized as a component of multiple organ dysfunction syndrome due to the lung's stereotypical response to diverse insults.
Purpose of the Study:
- To review the multifaceted management of pulmonary complications in critically ill patients.
- To discuss current and emerging ventilatory strategies for ARDS.
- To highlight the importance of fluid management, infection control, and potential pharmacologic interventions in ARDS.
Main Methods:
- Literature review of ARDS management strategies.
- Discussion of conventional and novel mechanical ventilation techniques.
- Analysis of fluid management, nosocomial pneumonia diagnosis, and pharmacologic therapies.
Main Results:
- Positive pressure ventilation with PEEP, while standard, carries risks like barotrauma.
- Newer ventilation modes (e.g., pressure-controlled, inverse-ratio ventilation, permissive hypercapnia) require further rigorous investigation.
- Fluid management is critical to support circulation while minimizing lung water.
- Aggressive diagnosis and management of nosocomial pneumonia are crucial due to its high mortality impact in ARDS.
- Inhaled nitric oxide shows promise in reducing pulmonary vascular pressures and intrapulmonary shunt.
Conclusions:
- Effective ARDS management requires a comprehensive approach beyond gas exchange support, including meticulous fluid management and vigilant infection control.
- While traditional ventilation methods are debated, novel strategies are emerging.
- Pharmacologic therapies, such as inhaled nitric oxide, offer potential benefits for specific ARDS manifestations, though their role in treating the underlying injury remains under investigation.