[TJS3] TSCCM-JSICM Symposium3
Mechanical ventilation

[TJS3-2] Mechanical ventilation in ARDS

Adisorn Wongsa (Phramongkutklao Hospital, Thailand)

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Current concept of mechanical ventilation in ARDS is a protective lung strategies which to provide the adequate oxygenation and less ventilator induce lung injuries (VILI). Our current understanding in physiology in stress and strain combine with driving pressure may guide the direction for ventilator setting in ARDS besides the low tidal volume will attend on appropriate of driving pressure, slower inspiratory flow, slow respiratory rate. Not only concern about VILI we will need to focus on hemodynamic disturbance from cardiopulmonary interaction between the patient and ventilator. The suggestion for ventilator setting that minimize effect on the right ventricular is gradual increase in pressure during inspiration , rapid drop in pressure after cycling to exhalation occurs , keep a mean airway pressure (mean PAW) during the expiratory period as near to atmospheric as possible and keep expiration time longer than inspiratory time to avoid acute Cor Pulmonale .The adjunct measurement is adding prone position as well as sedative and neuromuscular blocking agent to minimized transpleural pressure swing and to improve oxygenation.
Reference
Gattinoni et al. The future of mechanical ventilation: lessons from the present and the past, Critical Care, (2017) 21:183
Gustavo A. Cortes-Puentes,, Richard A. Oeckler,, John J. Marini; Ann Transl Med 2018;6(18):35