Publication: Personalized mechanical ventilation in acute respiratory distress syndrome
Issued Date
2021-12-01
Resource Type
ISSN
1466609X
13648535
13648535
Other identifier(s)
2-s2.0-85110521723
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Mahidol University
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SCOPUS
Bibliographic Citation
Critical Care. Vol.25, No.1 (2021)
Suggested Citation
Paolo Pelosi, Lorenzo Ball, Carmen S.V. Barbas, Rinaldo Bellomo, Karen E.A. Burns, Sharon Einav, Luciano Gattinoni, John G. Laffey, John J. Marini, Sheila N. Myatra, Marcus J. Schultz, Jean Louis Teboul, Patricia R.M. Rocco Personalized mechanical ventilation in acute respiratory distress syndrome. Critical Care. Vol.25, No.1 (2021). doi:10.1186/s13054-021-03686-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77557
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Title
Personalized mechanical ventilation in acute respiratory distress syndrome
Other Contributor(s)
IRCCS San Martino Polyclinic Hospital
Universite Paris-Saclay
Li Ka Shing Knowledge Institute
University Hospital Galway
Georg-August-Universität Göttingen
University of Minnesota Twin Cities
University of Melbourne
Università degli Studi di Genova
Tata Memorial Hospital
University of Toronto
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Hebrew University of Jerusalem
Royal Melbourne Hospital
Austin Hospital
Amsterdam UMC - University of Amsterdam
Universidade Federal do Rio de Janeiro
Universite Paris-Saclay
Li Ka Shing Knowledge Institute
University Hospital Galway
Georg-August-Universität Göttingen
University of Minnesota Twin Cities
University of Melbourne
Università degli Studi di Genova
Tata Memorial Hospital
University of Toronto
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Hebrew University of Jerusalem
Royal Melbourne Hospital
Austin Hospital
Amsterdam UMC - University of Amsterdam
Universidade Federal do Rio de Janeiro
Abstract
A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (VT) is a standard of care, further individualization of VT may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust VT and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda. [Figure not available: see fulltext.].