New ventilatory strategies in acute respiratory failure

New management options for acute respiratory failure aim at avoiding ventilator-induced lung injury while maintaining adequate gas exchange. Selected approaches examined in this article include methods to augment carbon dioxide elimination with tracheal gas insufflation, venovenous extracorporeal carbon dioxide removal, and intravascular oxygenation. Improving oxygenation can be accomplished by judicious use of positive end-expiratory pressure, venoarterial extracorporeal membrane oxygenation, and pharmacologic intervention with inhaled nitric oxide.