Spontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome

Current Opinion in Critical Care
Andreas GüldnerMarcelo Gama de Abreu

Abstract

This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS). Spontaneous breathing during assisted as well as nonassisted modes of mechanical ventilation improves lung function and reduces lung damage in mild and moderate ARDS. New modes of assisted mechanical ventilation with improved patient ventilator interaction and enhanced variability of the respiratory pattern offer additional benefit on lung function and damage. However, data supporting an outcome benefit of spontaneous breathing in ARDS, even in its mild and moderate forms, are missing. In contrast, controlled mechanical ventilation with muscle paralysis in the first 48 h of severe ARDS has been shown to improve survival, as compared with placebo. Currently, it is unclear whether ventilator settings, rather than the severity of lung injury, determine the potential of spontaneous breathing for benefit or harm. Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but consid...Continue Reading

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Jun 16, 2015·American Journal of Respiratory and Critical Care Medicine·Ewan C GoligherEddy Fan
Aug 26, 2014·Respiratory Physiology & Neurobiology·Steffen WirthStefan Schumann
Oct 18, 2016·American Journal of Respiratory and Critical Care Medicine·Jonne DoorduinLeo M A Heunks
Oct 28, 2016·American Journal of Respiratory and Critical Care Medicine·Takeshi YoshidaBrian P Kavanagh
Feb 6, 2019·Current Opinion in Critical Care·Takeshi YoshidaYuji Fujino
Dec 10, 2019·Current Opinion in Critical Care·Takeshi YoshidaYuji Fujino
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Apr 12, 2014·Current Opinion in Critical Care·Giacomo Bellani, Antonio Pesenti
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