Optimal Ventilation Strategy for Patients with ARDS Identified

The best ventilation strategy for patients suffering from Acute Respiratory Distress Syndrome (ARDS) continues to be a topic of extensive debate. During the course of a recent study, researchers have finally recognized optimal ventilation strategy in ARDS patients. 

ARDS is a condition in which lungs fail to oxygenate the blood resulting in severe hypoxia. The incidence of the condition is especially high in children. The condition is associated with a high mortality rate of about 27-45%. Mechanical ventilation is the single best procedure for saving the lives of patients with ARDS. Many studies have been carried out in an effort to formulate the best ventilation strategy that can reduce the high mortality rate associated with ARDS. 

This study was led by Enyou Li, MD, PhD, professor of anesthesiology in the Department of Anesthesiology at First Affiliated Hospital, Harbin Medical University, Harbin, China. For the purpose of data collection, The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were utilized. The results of this study were subsequently published in Scientific Reports. 

The study involved a meta-analysis entailing 36 randomized controlled trials during which 26 ventilation plans were applied on 6,685 patients. These ventilation plans were further categorized into 26 strategies on the basis of mode of ventilation, parameter settings, parameter value and operational techniques. Ventilator factors like positive end-expiratory pressure (PEEP), tidal volume (VT) ventilation, prone position, and other parameters were studied and compared with each other. 

The Optimal Ventilation Strategy

The researchers used various models to study the currently available ventilation strategies in patients with any underlying cause of ARDS. Network meta-analysis or mixed treatment comparison meta-analysis, MTC was used to compare the efficacy of various interventions. It was established that some of the ventilation strategies caused reduction in ARDS-related mortality more than the others. 

These optimal strategies include greater tidal volumes with fraction of inspired oxygen (FiO2)-guided lesser positive end-expiratory pressure (PEEP), pressure-controlled ventilation with FiO2-guided lesser PEEP and lesser tidal volumes with FiO2-guided lower PEEP along with prone position of the patient. 

The investigators found that some of the factors like permissive hypercapnia and low airway pressures were responsible for an increase in the mortality resulting from different causes in ARDS patients. The above mentioned factors constituted an optimized ventilation strategy that worked to reduce the mortality rate associated with ARDS. 

READ Do Cold And Flu Remedies Work?

According to James Stoller, MD, MS, a pulmonologist and chair of the Education Institute at the Cleveland Clinic and one of the researchers involved in this study, it is imperative to use 6 mL/kg tidal volume. This figure is centered on the ideal body mass index. These recommendations have not, as yet, been put to wide-spread use in ARDS patients which has prompted education for exercising this strategy. 

Employment of this ventilation strategy is expected to have major implications on the high mortality linked with ARDS. It is predicted that mortality rate will decline significantly following the implementation of this ventilation strategy in ARDS patients. The survival rate linked with this intervention has been estimated at 28%.