Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome
Abstract
:1. Introduction
2. Recognize That the Patient Has ARDS
3. Choose the Appropriate PEEP
3.1. General Consideration
3.2. How to Perform P-V Curve and PEEP Titration
- Sedate patients;
- Use succinylcholine 1 mg/kg IV and repeat until the breathing has been controlled;
- Always start from 0 cm H2O, targeting 35–40 cm H2O;
- Hold at the top for 5–15 s and then passively exhale;
- Pressure ramp: 3 cm H2O.
3.3. Alternative Approaches
3.4. Paralysis Strategy
4. Integrated Multiple Modalities for Severe Hypoxia: Prone, iNO, RM, and ECMO
4.1. Recruitment Maneuver
4.2. Meticulous PEEP Titration
4.3. iNO
4.4. Prone
4.5. ECMO
5. Lung Mechanics Safety Check
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Method | Advantage | Disadvantage |
---|---|---|
PEEP/FiO2 table [4,38] |
|
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PEEPIN view [32,33] |
|
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EIT [34,35] |
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Esophageal pressure-guided PEEP setting [7,36] |
|
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Recruitment-to-inflation ratio method [40,41] |
|
|
Lung ultrasound [42,43,44] |
|
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P-V curve [45] |
|
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Wang, C.-J.; Wang, I.-T.; Chen, C.-H.; Tang, Y.-H.; Lin, H.-W.; Lin, C.-Y.; Wu, C.-L. Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome. J. Pers. Med. 2024, 14, 779. https://doi.org/10.3390/jpm14080779
Wang C-J, Wang I-T, Chen C-H, Tang Y-H, Lin H-W, Lin C-Y, Wu C-L. Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome. Journal of Personalized Medicine. 2024; 14(8):779. https://doi.org/10.3390/jpm14080779
Chicago/Turabian StyleWang, Chieh-Jen, I-Ting Wang, Chao-Hsien Chen, Yen-Hsiang Tang, Hsin-Wei Lin, Chang-Yi Lin, and Chien-Liang Wu. 2024. "Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome" Journal of Personalized Medicine 14, no. 8: 779. https://doi.org/10.3390/jpm14080779